TABLE 2.

PG items reaching consensus

Item	Responses	Proportion agreement (%)
In a clinical practice setting, IBD-associated PG should be recognised by	An IBD specialist	88
	Dermatologist	94
IBD-associated PG should be clinically diagnosed by	Dermatologist	100
IBD-associated PG can be defined in the clinical practice setting via	Expert assessment of ulcerated and tender lesions with the exclusion of other etiologies	94
	Ulcerated lesions with biopsy of edge demonstrating neutrophilic infiltrate AND exclusion of other etiologies	75
	Any lesion meeting either 2018 Modified Delphi Consensus OR Paracelsus score criteriaa	75
The average patient with IBD-associated PG should be monitored via	Visits to IBD specialist	88
	Visits to Dermatologist	88
The average patient with IBD-associated PG should be seen	At the time of scheduled assessment of IBD with mild disease and every 1–3 months for moderate to severe disease requiring active intervention	88
Appropriate ways to assess for improvement or worsening of IBD-associated PG include	Patient report of change in size (measured with a tape measure) and/or degree of ulceration	81
	Physician assessment of subjective change in size	81
	Physician assessment of objective change in size	100
	Physician assessment of change in ulceration	88–94b
	Physician global assessmentc	76–92b
	Photographs demonstrating a change in size and/or degree of ulceration as per dermatology	94
Resolution of IBD-associated PG can be defined as	Patient report of absence of ulceration	94
	Physician assessment demonstrating no lesion(s)	100
	Photographs demonstrating no lesions as per dermatology	94
Recurrence of IBD-associated PG is defined as	A lesion that recurs anywhere	100
Timeline of recurrence of IBD-associated PG is defined as	Physician assessment of lesions returning any time after resolution	76
Patients with IBD-associated PG should be monitored for recurrence	As part of the standard of care visits with their IBD specialist	88
	As part of the standard of care visits with dermatology	88

Abbreviations: IBD, inflammatory bowel disease; PG, pyoderma gangrenosum.

^aThe 2018 Modified Delphi criteria are one major criterion – biopsy of ulcer edge demonstrating neutrophilic infiltrate and eight minor criteria: (1) exclusion of infections; (2) pathergy; (3) history of inflammatory bowel disease or inflammatory arthritis; (4) history of papule, pustule, or vesicle ulcerating within 4 days of appearing; (5) peripheral erythema, undermining border, and tenderness at ulceration site; (6) multiple ulcerations at least one on the anterior lower leg; (7) cribriform or “wrinkled paper” scar(s) at healed ulcer sites; and (8) decreasing ulcer size within 1 month of initiation immunosuppressive medication(s).³⁰ The Paracelsus Criteria are Progressing disease (defined as clinically evident ulcer developing within <6 weeks), Assessment of relevant differential diagnoses, Reddish-violaceous wound border, Amelioration by immunosuppressant drugs, Characteristically irregular (bizarre) ulcer shape, Extreme pain >4/10 on the visual analog scale, Localization of lesion at the site of trauma (pathergy phenomenon), Suppurative inflammation in histopathology, Undermined Wound Border, Systemic disease associated.³¹

^bRange in percentage is due to the inclusion of percentage agreement for improvement and for worsening (see Table S2 for a breakdown of percentages by individual items).

^cPhysician global assessment was defined by our panel with 100% consensus as the overall status of EIM based on patient symptoms, physical exam, and any relevant testing (imaging, laboratory data).