Ecthyma

Updated: Jun 07, 2016
  • Author: Loretta Davis, MD; Chief Editor: William D James, MD  more...
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Overview

Background

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. [1] On occasion, S aureus alone has been isolated. [2] Because ecthyma extends into the dermis, it is often referred to as a deeper form of impetigo.

Typical ecthyma lesions of the lower extremities. Typical ecthyma lesions of the lower extremities.
The stages of ecthyma: the lesion begins as a pust The stages of ecthyma: the lesion begins as a pustule that later erodes and ultimately forms an ulcer with adherent crust.
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Pathophysiology

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.

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Epidemiology

Frequency

The exact incidence of ecthyma worldwide remains unknown.

Race

No racial predisposition is recognized for ecthyma.

Sex

No sexual predisposition is recognized for ecthyma.

Age

Ecthyma has a predilection for children and elderly individuals. Outbreaks have also been reported in young military trainees. [3]

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Prognosis

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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Patient Education

For excellent patient education resources, see eMedicineHealth's Skin Conditions and Beauty Center. Also, see eMedicineHealth's patient education article Impetigo.

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