Ecthyma gangrenosum and ecthyma-like lesions: review article

Abstract

The generally accepted definition of ecthyma gangrenosum (EG) states that this condition is pathognomonic of Pseudomonas septicemia (Pseudomonas aeruginosa) and that it should usually be seen in immunocompromised patients, particularly those with underlying malignant disease. The cases described in the literature present a somewhat different picture. Our objective was to analyze this controversy. The review analyzes 167 cases of EG that were described in the literature from 1975 to 2014. All articles on EG cases with EG-specific tissue defect that had signs of general and/or local infection and skin necrosis were included and analyzed, whatever the etiology detected. Necrotic lesions of the skin diagnosed as EG have various microbiological etiology, can occur in immunocompetent or even healthy persons, and are not necessarily connected with septicemia. In published cases, P. aeruginosa was detected in 123 cases (73.65%); of them, there were only 72 cases (58.5%) with sepsis. Other bacterial etiology was detected in 29 cases (17.35%) and fungi were detected in 15 cases (9%). While the clinical picture of the disease and the treatment strategy remain the same, there is no need to invent two separate definitions for Pseudomonas and non-Pseudomonas cases. We suggest accepting a broader definition of EG.

Ecthyma gangrenosum aggravated by systemic antibiotics: A case report and literature review

“…Previously, ecthyma gangrenosum was assumed to be caused solely by P. aeruginosa and that too only in the immunocompromised patients [2].…”

“…Although previously thought to occur primarily due to P. aeruginosa infection, newer studies [2] have revealed the condition to be caused by other bacteria [3,4] and fungi [5,6] too. The lesion starts as an erythematous papule, which slowly evolves to form a haemorrhagic blister, which then deroofs to reveal a characteristic ulcer with dark necrotic eschar and surrounding erythema [1].…”

Ectima gangrenoso secundario a Staphylococcus aureus

“…Se manifiesta con máculas y pápulas que evolucionan a bulas hemorrá-gicas, que al denudarse, dejan úlceras que evolucionan con necrosis y un halo eritematoso periférico. En dos tercios de los casos las lesiones se localizan en los glúteos y extremidades inferiores 1 . Si bien la mayoría de las veces el EG es causado por Pseudomonas aeruginosa, otros agentes bacterianos, fúngicos e incluso virales se han asociado con esta entidad, planteando desafíos especialmente en el diagnóstico microbiológico y terapia antimicrobiana.…”

Ecthyma Gangrenosum in Paroxysmal Nocturnal Hemoglobinuria

“…It is characterized by a gunmetal gray infarcted macule or papule with surrounding erythema, which evolves into a necrotic, black, ulcerative eschar with an erythematous halo. The skin lesions usually appear in the gluteal and perineal regions (57%) or extremities (30%) but could appear anywhere [1]. …”

“…It is described that 58% of the patients with EG caused by PA suffered from sepsis or bacteremia. It is concluded that EG could also develop as a primary lesion without sepsis and bacteremia, and these patients usually have a better prognosis [1]. …”