Ecthyma is an ulcerative pyoderma of the skin well known to be caused by group A beta-hemolytic streptococci. Concomitant Staphylococcus aureus is often isolated from lesional skin.  On occasion, S aureus alone has been isolated.  Because ecthyma extends into the dermis, it is often referred to as a deeper form of impetigo.
Ecthyma begins similarly to superficial impetigo. Group A beta-hemolytic streptococci may initiate the lesion or may secondarily infect preexisting wounds. Preexisting tissue damage (eg, excoriations, insect bites, dermatitis) and immunocompromised states (eg, diabetes, neutropenia) predispose patients to the development of ecthyma. Spread of skin streptococci is augmented by crowding and poor hygiene.
The exact incidence of ecthyma worldwide remains unknown.
No racial predisposition is recognized for ecthyma.
No sexual predisposition is recognized for ecthyma.
Ecthyma has a predilection for children and elderly individuals. Outbreaks have also been reported in young military trainees. 
Ecthyma lesions are slow to heal but do respond to appropriate antibiotics and local wound care; prognosis is favorable.
Ecthyma rarely leads to systemic symptoms or bacteremia. Lesions are painful and can have associated lymphadenopathy. Secondary lymphangitis and cellulitis, as well as poststreptococcal glomerulonephritis, can occur. Ecthyma does heal with scarring.
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