Pyoderma vegetans

Last Updated: 2019-08-26

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Hallopeau 1898.

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

Chronic bacterial infection after banal injuries.

Often occurring in immunosuppressed patients.

  • Unknown.
  • Mostly β-hemolytic streptococci of group A, sometimes Staphylococcus aureus and Enterobakteriaceae, more rarely Gram-negative germs can also act as triggers.

  • Predisposition factors: Skin injuries, lymphomas, leukaemias, immunosuppressive diseases, alcoholism, malnutrition. 

Centrifugally expanding, finally coin to palm size, livid infiltrates with pustules, necroses, ulcers (partly fistulizing), with verrucous, papillomatous smeary secretions. A pus emptying is possible on pressure. In most cases, vegetating pyodermias are solitary lesions, rarely more than one can occur. The efflorescences heal scarring (bridge and tip scars).

Especially the extremities and the backs of the hands.

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

  • No spontaneous regression.

  • Narrow healing.
  • Antibiotics after antibiogram, otherwise:

  • For β haemolytic streptococci:

 

  • PenicillinG intravenously 4 Mio. IU 6x daily.

  • Erythromycin
  • Application: 4x daily 500 mg. p.o. (adults), maximum dose: 4 g/d (adults), 40-100 mg/kg bw/day (5-12 years).

  • CI: Hypersensitivity given Ingredients, liver dysfunction, concomitant therapy with ergotamine or dihydroergotamine or hepatotoxic drugs, dose adjustment recommended in renal or liver failure.

  • CAVE:
  • If there are signs of hepatotoxicity or ototoxicity, immediate discontinuation is indicated.

  • Aggravation of myasthenia gravis.

 

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

 

For staphylococcal infections:

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

 

  • Flucloxacillin p.o. or im 0.5-1.0 g 3-4x daily.

 

Topical Therapy

  • Quaternary ammonium compounds (Octenisept®) Application 1-2x daily (only for a short time)

 

  • Polihexanide (Lavasept) ® Concentration, solution

 

Surgical debridement or wound treatment appropriate for the stage of wound healing 

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  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.