Ecthyma - Causes, Symptoms and Treatment

Ecthyma is a skin infection similar to impetigo. Ecthyma is a skin infection characterised by crusted sores beneath which ulcers form. The bacterium Streptococcus is the most common infectious organism associated with ecthyma. Staphylococcus bacteria can also cause ecthyma. Preexisting tissue damage (eg, excoriations, insect bites, dermatitis) and immunocompromised states (eg, diabetes, neutropenia) predispose patients to the development of ecthyma. Spread of skin streptococci is augmented by crowding and poor hygiene. The infection may start at the site of an injury, such as a scratch or insect bite, and is often found on the legs. The infection may first appear with a pus-filled blister, similar to that seen in persons with impetigo. However, the infection spreads much deeper into the skin. Ecthyma rarely leads to systemic symptoms or bacteremia. Lesions are painful and can have associated lymphadenopathy. Secondary lymphangitis and cellulitis can occur. Ecthyma has a predilection for children and elderly individuals. Ecthyma lesion usually begins as a vesicle (small blister) or pustule on an inflamed area of skin. A hard crust that is harder and thicker than the crust of impetigo soon covers this. With difficulty, the crust can be removed to reveal an indurated ulcer that may be red, swollen and oozing with pus. Lesions may stay fixed in size and sometimes resolve spontaneously without treatment, or they may gradually enlarge to a sore of 0.5-3 cm in diameter. The areas most affected are the buttocks, thighs, legs, ankle and feet. Occasionally, the local lymph nodes become swollen and painful.

Ecthyma does heal with scarring. Ecthyma can be seen in areas of previously sustained tissue injury (eg, excoriations, insect bites, dermatitis). Ecthyma can be seen in patients who are immunocompromised. People of all ages and race can be affected, although children, elderly people and immunocompromised patients (e.g. diabetes, neutropenia, immunosuppressive medication, malignancy, HIV) tend to have a greater chance of infection. Treatment depends on the extent and severity of infection. A topical antibiotic ointment such as fucidic acid or mupirocin is often prescribed for localised ecthyma. A topical antiseptic such as povidone iodine, antibacterial Manuka honey or hydrogen peroxide cream may be used instead. Soak a clean cloth in a mixture of half a cup of white vinegar in a litre of tepid water. Apply the compress to moist areas for about ten minutes several times a day. Gently wipe off the crusts. Oral antibiotics are recommended if the infection is extensive or proving slow to respond to topical antibiotics. The preferred antibiotic is a penicillin, however the antibiotic chosen should be active against both Streptococcus pyogenes and Staphylococcus aureus (usually dicloxacillin or flucloxacillin). Placing a warm wet cloth over the area can help remove ulcer crusts. Any injury or bite should be thoroughly cleansed. A person should avoid scratching the skin even if it itches.

Causes of Ecthyma

Common Causes of Ecthyma

High temperature and humidity.
Crowded living conditions.
Poor hygiene.
Streptococcus bacteria
Injuries.

Sign and Symptoms of Ecthyma

Common Sign and Symptoms of Ecthyma

Vesicle ( Small blister).
Crusted ulcer.
Swollen
Oozing with pus.

Treatment for Ecthyma

Common Treatment for Ecthyma

Treatment depends on the extent and severity of infection. A topical antibiotic ointment such as fucidic acid or mupirocin is often prescribed for localised ecthyma. A topical antiseptic such as povidone iodine, antibacterial Manuka honey or hydrogen peroxide cream may be used instead.
Soak a clean cloth in a mixture of half a cup of white vinegar in a litre of tepid water. Apply the compress to moist areas for about ten minutes several times a day. Gently wipe off the crusts.
Oral antibiotics are recommended if the infection is extensive or proving slow to respond to topical antibiotics. The preferred antibiotic is a penicillin, however the antibiotic chosen should be active against both Streptococcus pyogenes and Staphylococcus aureus (usually dicloxacillin or flucloxacillin).
Placing a warm wet cloth over the area can help remove ulcer crusts. Any injury or bite should be thoroughly cleansed.
A person should avoid scratching the skin even if it itches.

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