Pyoderma vegetans

Hallopeau 1898.

Chronic vegetative pyoderma, pyodermites végétantes et verruqueuses, pyodermia chronica papillaris et exulcerans.

Chronic bacterial infection following trivial injuries.

Often occurring in immunocompromised patients.

• Unknown.
• Mostly β-haemolytic group A streptococci, sometimes Staphylococcus aureus and Enterobacteriaceae, less frequently Gram-negative germs may also act as triggers.

• Predisposing factors: Skin lesions, lymphomas, leukaemias, immunosuppressive diseases, alcoholism, malnutrition.

Centrifugally expanding, eventually coin- to palm-sized, livid infiltrates with pustules, necrosis, ulcers (some fistulating), with verrucous, papillomatous smeary secretion. Pus emptying is possible on pressure. In most cases, vegetating pyodermas are solitary lesions; rarely, several may occur. The efflorescences heal with scarring (bridge and pinnacle scars).

V.a. extremities and back of the hand.

Unspecific, epidermal hyperplasia, intra- and subepidermal neutrophilic microabscesses, dermal inflammatory infiltrate.

• No spontaneous regression.
• Scarring healing.

• Antibiotics according to antibiogram, otherwise:

• For β-haemolytic streptococci:

• PenicillinG i.v. 4 million IU 6x daily.

• Erythromycin
• Administration: 4x tgl. 500 mg. p.o.. (adults), maximum dose: 4 g/d (adult), 40-100 mg/kg bw/day (5-12 yrs).
• KI: Hypersensitivity gg. ingredients, liver dysfunction, concurrent therapy with ergotamine or dihydroergotamine or hepatotoxic drugs, dose adjustment recommended in renal or hepatic insufficiency.
• CAVE:
• If there is evidence of hepatotoxicity or ototoxicity, immediate discontinuation is indicated.
• Exacerbation of myasthenia gravis.

• Doxycycline p.o. 100 mg 1-2x daily for 14 days.

For staph infections:

• Cephalosporins e.g. cefuroxime p.o. 250-500 mg 2x tgl (> 12 yrs), 125 mg 2x tgl (5-12 yrs and ≥ 15 kg); i.v. 750 mg-1.5 g 3-4x tgl.

• Flucloxacillin p.o. or i.m. 0.5-1.0 g 3-4x tgl.

Topical therapy

• Quaternary ammonium compounds (Octenisept®) Applic. 1-2x tgl. (only for a short time)

• Polihexanide (Lavasept) ® concentration, solution

Surgical debridement or wound treatment appropriate to the stage

1. Schnetter D, Haneke E. [Pyoderma gangrenosum vegetans. An overview of chronic pyoderma vegetans and pyoderma gangrenosum]. Hautarzt 1994;45:635-8.
2. Scheinfeld N. Diseases associated with hidranitis suppurativa: part 2 of a series on hidradenitis. Dermatol Online J 2013;19:18558.
3. Leibovitch I, Ooi C, Huilgol SC, Reid C, James CL, Selva D. Pyodermatitis-pyostomatitis vegetans of the eyelids case report and review of the literature. Ophthalmology 2005;112:1809-13.
4. Papadopoulos AJ, Schwartz RA, Kapila R, et al. Pyoderma vegetans. J Cutan Med Surg 2001;5:223-7.