Ecthyma simplex

Last Updated: 2021-10-15

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Stokes 1807–1808.

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

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

  • During the Second World War often in Central Europe, today rather rarely.
  • Predisposition: 
    • Stay in a country with (sub)tropical climate
    • Poor hygiene (homeless people)
    • Small injuries
    • Folliculitis
    • Ictus reactions
    • Scabies 
    • Prurigo simplex subacuta
    • Chronic venous insufficiency
    • Reduced general condition
    • Acrocyanosis
    • Immunosuppression
    • HIV infection
    • Diabetes mellitus

Group A streptococci, more rarely Staphylococcus aureus, penetrate skin via lesions. The most common location is the lower leg, but skin changes can occur at any location.

Initially vesicles and pustules may appear. The pathogens work their way into the subcutaneous tissue, resulting in coin-sized, greasy, purulent, necrotic, punched-out ulcers with halo-like edges, some of which have honey-yellow crusts. Lymphangitis or locoregional lymphadenopathy may be associated.

  • Clinical features
  • Bacterial swab
  • Erysipelas
  • Sepsis
  • Glomerulonephritis
  • Weeks to months long course
  • Spontaneous healing tendency is very low
  • If fundamental causes are not remedied, a chronic recurrent course often occurs

Eliminate causal factors.

Topical Therapy

  • Moist dressings with antiseptics
  • Around the ulcers application of Pasta zinci mollis
  • Stage-specific wound care

Systemic Therapy

  • Penicillin V p.o. 1 Mega IU 3x daily for 10 days.
  • Alternatively: Erythromycin p.o. 500 mg 3x daily, maximum dose: 4 g/d (adult), 40-100 mg/kg bw/day (5-12 years)
  • Alternatively: Flucloxacillin p.o. or i.m. 3-4x daily 0.5-1.0 g.

  • Alternatively: Cefazolin i.v. 1-2 g twice daily (adults), 25-100 mg/kg bw/d in 3-4 single doses (children > 1 month)

  • Alternatively: Cefixim p.o. 400 mg once daily (≥12 yrs), 8 mg/kg bw/d once daily (<12 yrs)

  • Compression bandages.
  • At a body temperature of > 38°C take 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.