Ecthyma
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Contents |
Introduction
- Infection of the skin involving the dermis characterized by crusted erosions or ulcerations. A lesion of neglect. Develops in excoriations, insect bites, minor trauma in diabetics, elderly patients, soldiers & alcoholics.
Etiology
- (same as for impetigo)
- Staphylococcus aureus
- most commonly phage group 2, type 71 same etiologic agent as Staphylococcal scalded skin syndrome
- Streptococcus pyogenes
- primary infection of superficial break in skin
- secondary infection of pre-exsiting dermatosis
- predisposing factors
- colonization of skin by S aureus & S pyogenes
- warm ambient temperature
- high humidity
- neglect
Clinical-manifestations
- durations of lesions: weeks to months
- pain & tenderness
- ulceration with thick, adherent hemorrhagic crust
- lesions round or oval, may be > 3 cm in size
- distribution: ankles, dorsal aspect of feet, thighs, buttocks
- regional lymphadenopathy may be present
- often leaves a scar after healing
Complications
Differential-diagnosis
Management
- mupirocin ( Bactroban) TID to affected skin & to nares for 7-10 days
- benzoyl peroxide (prevention)
-
- penicillin VK 250 mg PO TID
- benzathine penicillin
- erythromycin 250-500 mg PO QID for 10 days
- cephalexin 250-500 mg QID for 10 days
- dicloxacillin 250-500 mg PO QID
- cephalexin
- 20 mg/kg/day divided TID for 10 days
- macrolides for penicillin-sensitive individuals
-
- clarithromycin 250-500 mg PO BID for 10 days
- azithromycin 250 mg QD for 5-7 days
- mupirocin ointment
- minocycline 100 mg PO BID for 10 days
- Bactrim DS 1-2 tabs QD
- ciprofloxacin 500 mg PO BID
More General Terms
Additional Terms
- diphtheria
- excoriation
- impetigo
- insect bite
- porphyria cutanea tarda (PCT)
- Staphylococcus aureus
- Streptococcus pyogenes
- venous stasis
References
Color Atlas & Synopsis of Clinical Dermatology, Common & Serious Diseases, 3rd ed, Fitzpatrick et al, McGraw Hill, NY, 1997, pg 604-609
