eMedicine Specialties > Dermatology > Bacterial Infections

Pyoderma Vegetans: Differential Diagnoses & Workup

Author: Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Coauthor(s): Justin Brown, MD, Dermatologist, The Dermatology Group
Contributor Information and Disclosures

Updated: Apr 22, 2009

Differential Diagnoses

Halogenoderma
Keratoacanthoma
Mycobacterium Marinum Infection of the Skin
Pyoderma Gangrenosum
Squamous Cell Carcinoma

Other Problems to Be Considered

Pyoderma vegetans may resemble and needs to be distinguished from cicatricial pemphigoid vegetans.19

Pyoderma vegetans mimics deep fungal infections at clinical examination. As a result of this clinical resemblance, pyoderma vegetans has been labeled both mycosislike pyoderma and blastomycosislike pyoderma. North American blastomycosis and pemphigus vegetans, a rare variant of the autoimmune disorder pemphigus vulgaris, also clinically resemble pyoderma vegetans. Rarely, other deep fungal infections, including phycomycosis and coccidioidomycosis, mimic the presentation of pyoderma vegetans.

Botryomycosis, a rare bacterial infection, may present similarly to a fungal infection and may appear similar to pyoderma vegetans. Cutaneous botryomycosis is differentiated by the presence of basophilic granules that resemble the sulfur granules of actinomyces at histologic examination.20 Depressed immunity is also common to cutaneous botryomycosis, as seen in acquired immunodeficiency syndrome (AIDS).21,22 In 1995, Marschalko et al suggested that cutaneous botryomycosis is a subtype of pyoderma vegetans, and they proposed that pyoderma vegetans and cutaneous botryomycosis should be classified together.23

Bromoderma, mycobacterial infections, and giant keratoacanthomas are also included in the differential diagnosis.

Workup

Laboratory Studies

  • Pathogenic organisms, such as Staphylococcus aureus, are grown from wound cultures, and cultures should also be taken for fungi and mycobacteria.
  • Direct and indirect immunofluorescence can aid in differentiating pyoderma vegetans (PV) and pemphigus vegetans.17,24
  • Hidradenitis suppurativa may cause an immune complex deposition in the skin, which precipitates the PV reaction. This reaction can be seen as a nonspecific immunoreactant deposition with direct immunofluorescence.17

Histologic Findings

Two predominant features are found in pyoderma vegetans: pseudocarcinomatous hyperplasia and numerous abscesses in both the hyperplastic epidermis and the dermis. The abscesses can be made up of neutrophils or eosinophils.

More on Pyoderma Vegetans

Overview: Pyoderma Vegetans
Differential Diagnoses & Workup: Pyoderma Vegetans
Treatment & Medication: Pyoderma Vegetans
Follow-up: Pyoderma Vegetans
Multimedia: Pyoderma Vegetans
References
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References

  1. Brown CS, Kligman AM. Mycosis-like pyoderma. AMA Arch Derm. Jan 1957;75(1):123-5. [Medline].

  2. Su WP, Duncan SC, Perry HO. Blastomycosis-like pyoderma. Arch Dermatol. Feb 1979;115(2):170-3. [Medline].

  3. Zilberberg B. Piodermite vegetante de Hallopeau e Peniggo vegetante. Sao Paulo: Empresa Grafica da;1960:1-180.

  4. Wozniacka A, Sysa-Jedrzejowska A, Schwartz RA. Chancriform pyoderma. Chronica Dermatologica (Roma). In Press.

  5. Hallopeau H. Pyodermite vegetante, ihre Beziehungen zur Dermatitis Herpetiformis and dem Pemphigus vegetans. Arch f Dermatol u Syph (Vienna). 1898;43:289-306.

  6. Welch KJ, Burke WA, Park HK. Pyoderma vegetans: association with diffuse T cell lymphoma (large cell type). J Am Acad Dermatol. Apr 1989;20(4):691-3. [Medline].

  7. Rongioletti F, Semino M, Drago F, Blangetti MG, Rebora A. Blastomycosis-like pyoderma (Pyoderma vegetans) responding to antibiotics and topical disodium chromoglycate. Int J Dermatol. Nov 1996;35(11):828-30. [Medline].

  8. Brunsting LA, Underwood LJ. Pyoderma vegetans in association with chronic ulcerative colitis. Arch Derm Syphilol. Aug 1949;60(2):161-72. [Medline].

  9. Bianchi L, Carrozzo AM, Orlandi A, Campione E, Hagman JH, Chimenti S. Pyoderma vegetans and ulcerative colitis. Br J Dermatol. Jun 2001;144(6):1224-7. [Medline].

  10. Trost LB, McDonnell JK. Important cutaneous manifestations of inflammatory bowel disease. Postgrad Med J. Sep 2005;81(959):580-5. [Medline].

  11. Potekaev NS, Iurin OG, Gorbacheva ZS, Potekaev SN, Pokrovskii VV. [Pyoderma vegetans as an early sign of HIV infection]. Ter Arkh. 1991;63(11):78-80. [Medline].

  12. Dutta TK, James J, Baruah MC, Ratnakar C. Blastomycosis-like pyoderma in a case of chronic myeloid leukaemia. Postgrad Med J. May 1992;68(799):363-5. [Medline].

  13. Follows GA, Mathew J, Lucas S, Black MJ, Goodship TH. Cutaneous botryomycosis in a patient with lupus nephritis. Nephrol Dial Transplant. Dec 1998;13(12):3200-1. [Medline].

  14. Ishibashi A, Kimura K. [A case of pyoderma vegetans (pyo-rhino-blepharo-stomatitis vegetans)]. Nippon Hifuka Gakkai Zasshi. Dec 1986;96(14):1649-53. [Medline].

  15. Skorepova M, Stuchlik D. Chronic pyoderma vegetans triggered by Trichophyton mentagrophytes. Mycoses. Mar 2006;49(2):143-4. [Medline].

  16. Ahn BK, Kim SC. Pyodermatitis-pyostomatitis vegetans with circulating autoantibodies to bullous pemphigoid antigen 230. J Am Acad Dermatol. May 2004;50(5):785-8. [Medline].

  17. Boyd AS, Zemtsov A. A case of pyoderma vegetans and the follicular occlusion triad. J Dermatol. Jan 1992;19(1):61-3. [Medline].

  18. Papadopoulos AJ, Schwartz RA, Kapila R, et al. Pyoderma vegetans. J Cutan Med Surg. May-Jun 2001;5(3):223-7. [Medline].

  19. Wozniak K, Gorkiewicz A, Olszewska M, Schwartz RA, Kowalewski C. Cicatricial pemphigoid vegetans. Int J Dermatol. Mar 2007;46(3):299-302. [Medline].

  20. Mehregan DA, Su WP, Anhalt JP. Cutaneous botryomycosis. J Am Acad Dermatol. Mar 1991;24(3):393-6. [Medline].

  21. Ahdoot D, Rickman LS, Haghighi P, Heard WU. Botryomycosis in the acquired immunodeficiency syndrome. Cutis. Mar 1995;55(3):149-52. [Medline].

  22. Salvemini JN, Baldwin HE. Botryomycosis in a patient with acquired immunodeficiency syndrome. Cutis. Sep 1995;56(3):158-60. [Medline].

  23. Marshalko M, Preisz K, Harsing J. Pyoderma Vegetans. Report on a case and review of data on pyoderma vegetans and cutaneous botryomycosis. Acta Derm Venerol APA (Ljubljana). 1995;4:55-59.

  24. Fujita M, Okamoto S. A case of pyoderma vegetans associated with acne conglobata. J Dermatol. Jul 1990;17(7):429-34. [Medline].

  25. Lip P. Sodium cromoglycate (Intal) in the management of chronic leg ulcers. Med J Aust. Jul 1 1978;2(1):32. [Medline].

  26. Massone L, Borghi S, Pestarino A, Gambini C. Topical disodium cromoglycate in the management of pyoderma gangrenosum. Cutis. Nov 1988;42(5):459-62. [Medline].

  27. Ichimiya M, Yamamoto K, Muto M. Successful treatment of pemphigus vegetans by addition of etretinate to systemic steroids. Clin Exp Dermatol. Jul 1998;23(4):178-80. [Medline].

  28. Sawchuk WS, Heald PW. Blastomycosis-like pyoderma--report of a case responsive to combination therapy utilizing minocycline and carbon dioxide laser debridement. J Dermatol Surg Oncol. Oct 1986;12(10):1041-4. [Medline].

  29. Yasuda M, Amano H, Nagai Y, Tamura A, Ishikawa O, Yamaguchi S. Pyodermatitis-pyostomatitis vegetans associated with ulcerative colitis: successful treatment with total colectomy and topical tacrolimus. Dermatology. 2008;217(2):146-8. [Medline].

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Further Reading

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Keywords

pyoderma vegetans, blastomycosis-like pyoderma, blastomycosislike pyoderma, mycosis-like pyoderma, mycosislike pyoderma

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Contributor Information and Disclosures

Author

Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

Coauthor(s)

Justin Brown, MD, Dermatologist, The Dermatology Group
Justin Brown, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society for MOHS Surgery, and Sigma Xi
Disclosure: medicis Honoraria Review panel membership; triax Honoraria Review panel membership

Medical Editor

Julie C Harper, MD, Assistant Program Director, Assistant Professor, Department of Dermatology, University of Alabama at Birmingham
Julie C Harper, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Stiefel Honoraria Speaking and teaching; Allergan Honoraria Speaking and teaching; Intendis Honoraria Speaking and teaching; Coria Honoraria Speaking and teaching; Sanofi-Aventis Honoraria Speaking and teaching

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

Van Perry, MD, Assistant Professor, Department of Medicine, Division of Dermatology, University of Texas Health Science Center
Van Perry, MD is a member of the following medical societies: American Academy of Dermatology and American Society for Laser Medicine and Surgery
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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