eMedicine Specialties > Dermatology > Bacterial Infections

Pyoderma Vegetans: Treatment & Medication

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

Treatment

Medical Care

No standardized treatment plan is available for pyoderma vegetans (PV), although antibiotic treatment has often been used with variable results.

  • Topical wound care with copper sulfate or aluminum subacetate dressings and intravenous antibiotics successfully treated 5 of 7 patients with pyoderma vegetans.2
  • Topical aluminum acetate soaks with intravenous ceftriaxone had moderate success at clearing pyoderma vegetans in another patient.17
  • Over a course of 2 months, the application of zinc oxide along with the intralesional injection of corticosteroids completely cleared lesions on the perianal area of 1 patient.24
  • A vegetating lesion on the dorsum of a patient's hand was completely cleared with 4 weeks of 2 g of ampicillin daily and x-ray irradiation.23
  • In the treatment of 1 patient whose lesions were refractory to antibiotic treatment, topical application of disodium chromoglycate, which is used for the management of chronic leg ulcers25 and pyoderma gangrenosum,26 induced the healing of lesions.7
  • Ichimiya et al reported successful treatment with etretinate and systemic steroids.27

Surgical Care

Antibiotic treatment has been successfully supplemented with laser debridement or curettage to clear lesions.28

Medication

The goals of pharmacotherapy are to reduce morbidity and to prevent complications. Reportedly, pyodermatitis-pyostomatitis vegetans associated with ulcerative colitis has been successfully treated in one patient with total colectomy and topical tacrolimus.29

Topical skin products

Applied locally, these products may dry affected area by reducing the secretory function of the skin glands. They may also toughen the skin to help prevent reinfections, and they may have antiseptic properties.


Aluminum acetate (Burow solution)

Dissolve aluminum acetate tablets in water to get a 1:10 to 1:40 solution. Has a drying effect on vesicular or wet dermatoses.

Adult

Apply as a compress for 20-30 min 4-6 times/d

Pediatric

Apply as in adults

Pregnancy

A - Fetal risk not revealed in controlled studies in humans

Precautions

For external use only


Zinc oxide

Provides relief of minor skin irritations.

Adult

Apply to affected areas prn

Pediatric

Apply as in adults

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

For external use only; do not apply to eyes

Antibiotics

Therapy must cover all likely pathogens in the context of this clinical setting.


Ampicillin (Marcillin, Omnipen, Polycillin, Principen, Totacillin)

Bactericidal activity against susceptible organisms. Alternative to amoxicillin when unable to take medication orally.

Adult

2 g/d PO/IV/IM divided qid

Pediatric

Not established

Probenecid and disulfiram increase levels; allopurinol decreases effects and has additive effects on ampicillin rash; may decrease effects of oral contraceptives

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Adjust dose in renal failure; evaluate rash and differentiate from hypersensitivity reaction

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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