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Pyoderma Vegetans Differential Diagnoses

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Jun 09, 2016
 
 

Diagnostic Considerations

Pyoderma vegetans may resemble and needs to be distinguished from cicatricial pemphigoid vegetans[24] and from localized pemphigus vegetans, which may be seen lacking mucosal lesions.[25] The large verrucous plaques of pyoderma vegetans may also suggest verrucous carcinoma.[26]

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.[27] Depressed immunity is also common to cutaneous botryomycosis, as seen in acquired immunodeficiency syndrome (AIDS).[28, 29] 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.[30]

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

On the penis, it must be distinguished from penile cancer.[23]

Pyodermatitis-pyostomatitis vegetans, a rare mucocutaneous inflammatory disorder evident as vesicular, pustular, exudative, and vegetating plaques and frequently associated with ulcerative colitis, may require distinction.[31]

It should be distinguished also from pyoderma gangrenosum.[32]

Differential Diagnoses

 
 
Contributor Information and Disclosures
Author

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.

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, Sigma Xi

Disclosure: Received honoraria from Medicis for review panel membership; Received honoraria from Triax for review panel membership.

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.

Van Perry, MD Assistant Professor, Department of Medicine, Division of Dermatology, University of Texas School of Medicine at San Antonio

Van Perry, MD is a member of the following medical societies: American Academy of Dermatology

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

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: Received honoraria from Stiefel for speaking and teaching; Received honoraria from Allergan for speaking and teaching; Received honoraria from Intendis for speaking and teaching; Received honoraria from Coria for speaking and teaching; Received honoraria from Sanofi-Aventis for speaking and teaching.

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

  2. Su WP, Duncan SC, Perry HO. Blastomycosis-like pyoderma. Arch Dermatol. 1979 Feb. 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. 1989 Apr. 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. 1996 Nov. 35(11):828-30. [Medline].

  8. Brunsting LA, Underwood LJ. Pyoderma vegetans in association with chronic ulcerative colitis. Arch Derm Syphilol. 1949 Aug. 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. 2001 Jun. 144(6):1224-7. [Medline].

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

  11. Vahedi H, Nozari N, Sotoudeh M. Report of a Rare Case of Nasal Mucosa Pyoderma Vegetans in a Patient with Ulcerative Colitis. Middle East J Dig Dis. 2015 Apr. 7 (2):104-6. [Medline].

  12. 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].

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

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

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

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

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

  18. Vesic S, Bogdanovic A, Medenica L, Bremec T, Pavlovic MD. Pyoderma vegetans in a patient with myelodysplastic syndrome. Int J Dermatol. 2009 Jun. 48(6):665-6. [Medline].

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

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

  21. Matias Fde A, Rosa DJ, Carvalho MT, Castañon MC. Pyodermatitis-pyostomatitis vegetans: case report and review of medical literature. An Bras Dermatol. 2011 Jul-Aug. 86(4 Suppl 1):S137-40. [Medline].

  22. Cerullo L, Zussman J, Young L. An unusual presentation of blastomycosislike pyoderma (pyoderma vegetans) and a review of the literature. Cutis. 2009 Oct. 84(4):201-4. [Medline].

  23. Ovhal AG, Deshmukh AR. Pyoderma vegetans of glans penis. Indian J Dermatol. 2012 Jan. 57(1):71-2. [Medline]. [Full Text].

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

  25. Jain V, Jindal N, Imchen S. Localized Pemphigus Vegetans without Mucosal Involvement. Indian J Dermatol. 2014 Mar. 59(2):210. [Medline]. [Full Text].

  26. Aksu Çerman A, Aktaş E, Kıvanç Altunay İ, Demirkesen C. Pyoderma Vegetans Misdiagnosed as Verrucous Carcinoma. Am J Dermatopathol. 2016 Feb. 38 (2):148-50. [Medline].

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

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

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

  30. 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.

  31. Stingeni L, Tramontana M, Bassotti G, Bianchi L, Lisi P. Pyodermatitis-pyostomatitis vegetans and anti-BP180 autoantibodies: a casual association?. Br J Dermatol. 2014 Jul 26. [Medline].

  32. Romańska-Gocka K, Cieścińska C, Zegarska B, Schwartz RA, Cieściński J, Olszewska-Słonina D, et al. Pyoderma gangrenosum with monoclonal IgA gammopathy and pulmonary tuberculosis. Illustrative case and review. Postepy Dermatol Alergol. 2015 Apr. 32 (2):137-41. [Medline].

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

  34. Canpolat F, Cemil BÇ, Yilmazer D, Yesilli O, Eskioglu F. Pyoderma vegetans associated with ulcerative colitis: a case with good response to steroids. Case Rep Dermatol. 2011 Mar 26. 3(1):80-4. [Medline]. [Full Text].

  35. Kumar S, Boyce Z, McKay C, Casey G. PYODERMA VEGETANS WITH lg A DEFICIENCY. Indian J Dermatol. 2010 Oct. 55(4):379-80. [Medline]. [Full Text].

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

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

  38. Molodoi AD, Dimitriu A, Andronic CD, Stoleriu G, Bădescu A, Boda D, et al. Pyoderma vegetans developed on chronic leg ulcer. Rev Med Chir Soc Med Nat Iasi. 2015 Jan-Mar. 119 (1):107-11. [Medline].

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

  40. Coulombe J, Bertrand J, Lavoie M, Lessard M, Leclerc G, Dupéré A. [Pyoderma vegetans due to Candida albicans: successful treatment with itraconazole]. Ann Dermatol Venereol. 2012 Dec. 139(12):836-7. [Medline].

  41. Wang H, Qiao S, Zhang X, Liu C. A case of pyodermatitis-pyostomatitis vegetans. Am J Med Sci. 2013 Feb. 345(2):168-71. [Medline].

  42. 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. 1986 Oct. 12(10):1041-4. [Medline].

  43. Radoš J, Paštar Z, Rudman F, Milavec-Puretic V, Lipozencic J, Dobric I. Pyoderma chronica vegetans treated with mesh skin grafting. Acta Dermatovenerol Croat. 2011 Sep. 19(3):180-2. [Medline].

  44. 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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