Ecthyma simplex

Stokes 1807-1808.

Ecthyma, Ecthyma simplex, Staphylodermia ecthymatosa, Streptodermia ecthymatosa, Ecthyma simplex streptogenes.

Ulcerating, "punched out" looking ulcers. In and of itself, the term "ecthyma" is a morphological term. A distinction is made between ecthymata contagiosum (Orf), which is triggered by poxviruses, ecthymata gangraenosum (intertriginous ulcerations triggered by Pseudomonas aeruginosa) and ulcerations triggered by group A streptococci and staphylococci, which are referred to as ecthymata simplex.

• Frequent in Central Europe during World War 2, rather rare today

• Predisposition:
  • Staying in a country with a (sub-)tropical climate
  • Poor hygiene (homeless)
  • Small injuries
  • Folliculitis
  • Ictus reactions
  • Skabies
  • Prurigo simplex subacuta
  • Chronic venous insufficiency
  • Reduced general condition
  • Acrocyanosis
  • Immune suppression
  • HIV infection
  • Diabetes mellitus

Group A streptococci, less frequently Staphylococcus aureus, invade the skin via injuries. The most common location is the lower leg, but skin lesions can occur at any location.

Initially, vesicles and pustules may appear. As the pathogens progress, they work their way into the subcutaneous tissue, which is why coin-sized, smeary, sometimes honey-yellow crusted, purulent, necrotic, punched-out-looking ulcers with halo-like margins develop. Lymphangitis or locoregional lymphadenopathy may be associated

• Clinic
• Bact. smear

• Erysipelas
• Sepsis
• Glomerulonephritis

• Weeks to months long course
• Spontaneous healing tendency is very low
• If underlying causes are not remediated, a chronic recurrent course
often occurs

Eliminate causal factors.

Topical therapy:

• Moist dressings with antiseptics
• Around the ulcers application of pasta zinci mollis
• Stage appropriate wound care

Systemic therapy:

• PenicillinV p.o. 1 Mega IU 3x tgl. for 10 days
• Alternatively: erythromycin p.o. 500 mg 3x tgl, maximum dose: 4 g/d (adult), 40-100 mg/kg bw/day (5-12 y.o.)
• Alternatively: Flucloxacillin p.o. or i.m. 3-4x tgl. 0.5-1.0 g.
• Alternatively: cefazolin i.v. 1-2 g 2x tgl. (adults), 25-100 mg/kg bw/d in 3-4 single doses (children > 1 month)
• Alternatively: cefixime p.o. 400 mg 1x tgl. (≥12 yrs), 8 mg/kg bw/d 1x tgl. (<12 yrs)
• Compression bandages
• At a body temperature of > 38°C collection of blood cultures

1. Schirren JM. [Chronic serpiginous pyoderma of the ecthyma simplex type as an occupational skin disease in a butcher]. Z Haut Geschlechtskr 1969;44:107-12.
2. Kimyai-Asadi A, Tausk FA , Nousari HC. Ecthyma secondary to herpes simplex virus infection. Clin Infect Dis 1999;29:454-5.