Ecthyma Treatment & Management
- Author: Loretta Davis, MD; Chief Editor: William D James, MD more...
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.
Oral penicillin is the standard of care for documented streptococcal ecthyma. Typically, a 7-day course is adequate. If concomitant or primary S aureus infection is suspected, oral dicloxacillin and cephalexin are recommended as isolates are typically methicillin-susceptible. 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. If methicillin-resistant S aureus is isolated or suspected, doxycycline, clindamycin, and sulfamethoxazole-trimethoprim are therapeutic options. Consider parenteral antibiotics for widespread ecthyma and in the setting of community outbreaks of poststreptococcal glomerulonephritis.
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:
Gently debride ecthyma crusts.
Ecthyma rarely produces systemic symptoms.
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.
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.
Kelly C, Taplin D, Allen AM. Streptococcal ecthyma. Treatment with benzathine pencillin G. Arch Dermatol. 1971 Mar. 103(3):306-10. [Medline].
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].
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].
Ko WT, Adal KA, Tomecki KJ. Infectious diseases. Med Clin North Am. 1998 Sep. 82(5):1001-31, v. [Medline].
Singh G. Heat, humidity and pyodermas. Dermatologica. 1973. 147(5):342-7. [Medline].
Allen AM, Taplin D, Twigg L. Cutaneous streptococcal infections in Vietnam. Arch Dermatol. 1971 Sep. 104(3):271-80. [Medline].
Gunawardane ND, Laumann A. An immunocompromised patient with recent-onset skin lesions. JAMA. 2014 Mar 5. 311 (9):957-8. [Medline].
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].
[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].
Duve S, Voack C, Rakoski J, Hoffmann H. Extensive inguinal lymphadenitis. Ecthyma with inguinal lymphadenitis. Arch Dermatol. 1996 Jul. 132(7):823, 826. [Medline].
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.