Ecthyma gangrenosum


A skin lesion that is usually associated with systemic infection.

Occasionally can occur as a result of local inoculation of infective organisms.

A small vessel vasculitis, resulting from the invasion of vessels in the skin by infective organisms.

Results in necrosis of the vessel wall from vascular occlusion, with the consequent necrotic ulceration of the skin.

The lesion usually begins as a hemorrhagic pustule or blister, which eventually breaks down into an ulcer.

The base of the ulcer frequently is covered with a dark scab.

The margins ofthelesion and surrounding skin demonstrate erythema and edema.

Organisms including Staphylococcal aureus, E. coli, Citrobacter freundii, Klebsiella pneumonie, Morganella morganii, Candida albicans, Mucor, Fusaarium, and viruses.

The most common causes of organism is P aeruginosa, accounting for more than 70% of cases.

Most commonly occurs in patients with immunosuppressed states such as malignancy, neutropenia, AIDS, malnutrition, and diabetes.

Treatment requires control of the systemic infection with antibiotics.

If the lesion is refractory to medical management, surgical debridement may be necessary.

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