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Ecthyma Information and Treatment

Ecthyma is a skin infection similar, to but more deeply invasive than impetigo. It is a deep form of impetigo as the same bacteria causing the infection are involved but ecthyma causes deeper erosions of the skin. Ecthyma gangrenosum is characterized by single or multiple, cutaneous or mucous membrane ulcers that are most often associated with prolonged neutropenia, Pseudomonas aeruginosa bacteremia , and other serious bacterial infections. Mortality rates of patients affected by ecthyma gangrenosum depends on the severity of the underlying sepsis, with mortality ranging from 38% to 96%. Patients are likely to have an underlying condition, such as cancer, immunodeficiency syndrome, extensive burns, and malnutrition. It typically involves the extremities, gluteal and perineal regions. The predisposing factor that can lead to ecthyma gangrenosum is the presence of any kind of immunodeficiency associated with severe neutropenia. An ecthyma may begin with a pus-filled blister, similar to that seen in impetigo. However, the infection goes through the outer layer of skin and into the deeper layer. An ulcer with raised borders develops. Ecthyma is characterized by small, purulent, shallow, punched-out ulcers with thick, brown-black crusts and surrounding erythema. In young lambs, the initial lesion may develop on the gum below the incisor teeth. The lesions develop as papules and progress through vesicular and pustular stages before encrusting.

Children with Ecthyma gangrenosum may develop diarrhea before the onset of cutaneous lesions. This disease is a life-threatening septicaemic infection and has a high mortality. The infection may start at the site of an injury, such as a scratch or insect bite, and is often found on the legs. A hard crust that is harder and thicker than the crust of impetigo soon covers this. The underlying pathogenic mechanism of ecthyma gangrenosum is thought to be a vasculitis caused directly by enzymes and toxins elaborated by the bacteria present. Untreated ecthymatous lesions can enlarge over the course of weeks or months to a diameter of 2 to 3 cm. While a few case reports describe the development of EG in previously healthy children, most of these patients had previously unrecognized risk factors for the development of EG, including intra-abdominal or appendiceal abscesses, recent viral illness, or antibiotic treatment for underlying medical conditions such as hypogammaglobulinemia and neutropenia. Treatment should include prompt recognition of the skin lesion, appropriate antibiotic therapy for Pseudomonas aeruginosa, and surgical debridement.

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