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Ecthyma Gangrenosum Treatment & Management

  • Author: Mina Yassaee Kingsbery, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Aug 12, 2016
 

Medical Care

Ecthyma gangrenosum (EG) requires prompt diagnosis and treatment with appropriately selected antibiotics for the underlying etiology. If the lesion fails to respond to antimicrobials, surgical debridement of the spreading, necrotic lesion may be required.[20, 21] The presence of EG should alert the physician to the likelihood of pseudomonal bacteremia, and the early implementation of antimicrobial agents is necessary to reduce the high mortality associated with pseudomonal sepsis.

Treatment of EG requires the use of antipseudomonal penicillins, aminoglycosides, fluoroquinolones, third-generation cephalosporins, or aztreonam. While awaiting results, an antipseudomonal penicillin (piperacillin) should be used in conjunction with an aminoglycoside (gentamicin). Further adjustment of antibiotics may be required after sensitivity results are known. Granulocyte-macrophage colony-stimulating factor may also be administered to patients with severe leukopenia and ecthyma gangrenosum to aid in recovery.[22]

Systemic antifungal coverage should be considered if fungemia is suspected, including coverage against Aspergillus, Candida, and Mucor species with azole agents (eg, voriconazole, fluconazole) and/or amphotericin B if appropriate.

If empiric antimicrobial and antifungal therapy is used, it must be comprehensive and should cover all likely pathogens in the context of the clinical setting. Antibiotic selection should be guided by blood culture sensitivity results whenever feasible.

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Consultations

See the list below:

  • Dermatologist - For evaluation of cutaneous lesions
  • Infectious disease specialist - For evaluation and treatment of infection
  • Internist or pediatrician - For evaluation of possible immunocompromised states
  • General surgeon - For evaluation of possible surgical excision of lesions that failed to respond to antibiotics
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Contributor Information and Disclosures
Author

Mina Yassaee Kingsbery, MD Co-Chief Resident, Department of Dermatology, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons

Mina Yassaee Kingsbery, MD is a member of the following medical societies: American Academy of Dermatology, Society for Pediatric Dermatology, Women's Dermatologic Society

Disclosure: Nothing to disclose.

Coauthor(s)

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.

Specialty Editor Board

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Christen M Mowad, MD Professor, Department of Dermatology, Geisinger Medical Center

Christen M Mowad, MD is a member of the following medical societies: Alpha Omega Alpha, Noah Worcester Dermatological Society, Pennsylvania Academy of Dermatology, American Academy of Dermatology, Phi Beta Kappa

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.

Acknowledgements

Sarina Berger Elmariah, MD, PhD Resident Physician, Robert O Perelman Department of Dermatology, New York University School of Medicine

Sarina Berger Elmariah, MD, PhD is a member of the following medical societies: Phi Beta Kappa

Disclosure: Nothing to disclose.

Frederick Fish, MD Director, Department of Dermatology and Cutaneous Surgery, St Paul Ramsey Medical Center; Associate Clinical Professor, Department of Dermatology, University of Minnesota

Frederick Fish, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American College of Physicians, American Medical Association, American Society for Laser Medicine and Surgery, American Society of Dermatopathology, Pacific Dermatologic Association, and Sigma Xi

Disclosure: Nothing to disclose.

Nobuyoshi Kageyama, MD Resident Physician, Assistant Clinical Professor of Dermatology, Department of Dermatology, University of Texas Southwestern Medical Center at Dallas, Southwestern Medical School

Disclosure: Nothing to disclose.

Ravi Ubriani, MD Assistant Professor of Clinical Dermatology, Department of Dermatology, Columbia University Medical Center

Disclosure: Nothing to disclose.

References
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