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Ecthyma Treatment & Management

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

Medical Care

Oral antibiotics are used to treat ecthyma. Hygiene is also important. Maintain cleanliness by using bactericidal soap and frequently changing bed linens, towels, and clothing. Remove ecthyma crusts by soaking or using wet compresses. Lesions should then be covered with petroleum jelly or mupirocin ointment.[8]

Oral penicillin is the standard of care for documented streptococcal ecthyma. Typically, a 7-day course is adequate.[9] If concomitant or primary S aureus infection is suspected, oral dicloxacillin and cephalexin are recommended as isolates are typically methicillin-susceptible.[9] Of interest, a 1971 study by Kelly et al demonstrated benzathine penicillin G eradication of streptococci and clinical healing of ecthyma lesions despite the concomitant presence of staphylococci.[1] If methicillin-resistant S aureus is isolated or suspected, doxycycline, clindamycin, and sulfamethoxazole-trimethoprim are therapeutic options.[9] Consider parenteral antibiotics for widespread ecthyma and in the setting of community outbreaks of poststreptococcal glomerulonephritis.[9]

Additional FDA-approved antibiotics for the treatment of acute bacterial skin and skin structure infections include oritavancin (Orbactiv), dalbavancin (Dalvance), and tedizolid (Sivextro). These agents are active against Staphylococcus aureus (including methicillin-susceptible and methicillin-resistant S aureus [MSSA, MRSA] isolates), Streptococcus pyogenes, Streptococcus agalactiae, and Streptococcus anginosus group (includes Streptococcus anginosus, Streptococcus intermedius, and Streptococcus constellatus), among others. For complete drug information, including dosing, see the following monographs:

 

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Surgical Care

Gently debride ecthyma crusts.

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Complications

Ecthyma rarely produces systemic symptoms.

Invasive complications of streptococcal skin infections include cellulitis, erysipelas, gangrene, lymphangitis, suppurative lymphadenitis,[10] bursitis,[3] lobar pneumonia,[3] and bacteremia.

Nonsuppurative complications of streptococcal skin infections include scarlet fever and acute glomerulonephritis. Prompt antibiotic therapy does not appear to reduce the rate of poststreptococcal glomerulonephritis. Streptococcal toxic shock syndrome has been reported.[3]

Possible sequelae of secondary untreated S aureus pyodermas include cellulitis, lymphangitis, bacteremia, osteomyelitis, and acute infective endocarditis. Some S aureus strains produce exotoxins that can lead to staphylococcal scalded skin syndrome and toxic shock syndrome.

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Prevention

Maintaining cleanliness is critical for preventing ecthyma. Using insect repellants to prevent bites also may decrease the prevalence of ecthyma.

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Contributor Information and Disclosures
Author

Loretta Davis, MD Professor, Department of Internal Medicine, Division of Dermatology, Medical College of Georgia

Loretta Davis, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Lester F Libow, MD Dermatopathologist, South Texas Dermatopathology Laboratory

Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Texas Medical Association

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Donald Belsito, MD Professor of Clinical Dermatology, Department of Dermatology, Columbia University Medical Center

Donald Belsito, MD is a member of the following medical societies: New York County Medical Society, Noah Worcester Dermatological Society, Phi Beta Kappa, American Contact Dermatitis Society, Dermatology Foundation, Dermatologic Society of Greater New York, Alpha Omega Alpha, American Academy of Dermatology

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Carmen Mays, MD, to the development and writing of this article.

References
  1. Kelly C, Taplin D, Allen AM. Streptococcal ecthyma. Treatment with benzathine pencillin G. Arch Dermatol. 1971 Mar. 103(3):306-10. [Medline].

  2. Hochedez P, Canestri A, Lecso M, Valin N, Bricaire F, Caumes E. Skin and soft tissue infections in returning travelers. Am J Trop Med Hyg. 2009 Mar. 80 (3):431-4. [Medline].

  3. Wasserzug O, Valinsky L, Klement E, et al. A cluster of ecthyma outbreaks caused by a single clone of invasive and highly infective Streptococcus pyogenes. Clin Infect Dis. 2009 May 1. 48(9):1213-9. [Medline].

  4. Ko WT, Adal KA, Tomecki KJ. Infectious diseases. Med Clin North Am. 1998 Sep. 82(5):1001-31, v. [Medline].

  5. Singh G. Heat, humidity and pyodermas. Dermatologica. 1973. 147(5):342-7. [Medline].

  6. Allen AM, Taplin D, Twigg L. Cutaneous streptococcal infections in Vietnam. Arch Dermatol. 1971 Sep. 104(3):271-80. [Medline].

  7. Gunawardane ND, Laumann A. An immunocompromised patient with recent-onset skin lesions. JAMA. 2014 Mar 5. 311 (9):957-8. [Medline].

  8. Dagan R, Bar-David Y. Double-blind study comparing erythromycin and mupirocin for treatment of impetigo in children: implications of a high prevalence of erythromycin-resistant Staphylococcus aureus strains. Antimicrob Agents Chemother. 1992 Feb. 36(2):287-90. [Medline].

  9. [Guideline] Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of america. Clin Infect Dis. 2014 Jul 15. 59(2):e10-52. [Medline]. [Full Text].

  10. Duve S, Voack C, Rakoski J, Hoffmann H. Extensive inguinal lymphadenitis. Ecthyma with inguinal lymphadenitis. Arch Dermatol. 1996 Jul. 132(7):823, 826. [Medline].

  11. Barclay L. IDSA: skin and soft tissue infections guidelines updated. Medscape Medical News. Available at http://www.medscape.com/viewarticle/827399. Accessed: June 26, 2014.

 
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Typical ecthyma lesions of the lower extremities.
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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