Ecthyma Clinical Presentation
- Author: Loretta Davis, MD; Chief Editor: William D James, MD more...
Ecthyma usually arises on the lower extremities of children, persons with diabetes, and neglected elderly patients. During wartime in tropical climates, ecthymatous ulcers are commonly found on the ankles and dorsi of the feet.
Ecthyma begins as a vesicle or pustule overlying an inflamed area of skin that deepens into a dermal ulceration with overlying crust. The crust of ecthyma lesions is gray-yellow and is thicker and harder than the crust of impetigo. A shallow, punched-out ulceration is apparent when adherent crust is removed. The deep dermal ulcer has a raised and indurated surrounding margin.
Ecthyma lesions can remain fixed in size (sometimes resolving without treatment) or can progressively enlarge to 0.5-3 cm in diameter.
Ecthyma heals slowly and commonly produces a scar.
Regional lymphadenopathy is common, even with solitary lesions.
Ecthyma can be seen in areas of previously sustained tissue injury (eg, excoriations, insect bites, dermatitis). Insect bites in the setting of recent travel have been associated with ecthyma.
Ecthyma can be seen in patients who are immunocompromised (eg, diabetes, neutropenia, HIV infection).
Important factors that contribute to the development of streptococcal pyodermas or ecthyma include the following:
High temperature and humidity [5, 6]
Crowded living conditions
Untreated impetigo that progresses to ecthyma most frequently occurs in patients with poor hygiene.
Some strains of Streptococcus pyogenes have a high affinity for both pharyngeal mucosa and skin. Pharyngeal colonization of S pyogenes has been documented in patients with ecthyma. Ecthyma has also been reported in the setting of perianal streptococcal disease.
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