Pyoderma vegetating L08.0

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 11.10.2021

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Synonym(s)

Chronic vegetative pyoderma; Dispensing Pyoderma; Pyoderma chronic vegetative; pyoderma vegetans; Pyodermia chronica papillaris et exulcerans; Pyodermites végétantes et verruqueuses; Vegetative pyoderma

History
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Hallopeau 1898; Nanta and Bazex 1937

Definition
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Increasingly rarely used, only vaguely defined term for a "chronic, fistulating, peripherally progressive, therapy-resistant pyoderma", which may occur after trivial injuries and then develops a momentum of its own. Such chronic, also fistulating pyodermas are mainly found in immunocompromised patients. Such vegetating skin suppurations can also occur in the wake of a therapy-resistant leg ulcer. The distinction from pyoderma gangraenosum appears to be "fluid", especially since the occurrence of vegetating pyoderma has been described in ulcerative colitis in the same way as pyoderma gangraenosum ( Bianchi L et al. 2001).

Pathogen
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Mostly beta-hemolytic Group A Streptococci or Staphylococcus aureus. More rarely, Gram-negative germs or a mixed flora are the triggers (Molodoi AD et al. 2015).

Etiopathogenesis
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Defects of humoral or cellular immunity, predisposing local factors, virulent pathogens, infection of an underlying skin lesion

Localization
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Localized mainly on the extremities, especially on the lower legs.

Clinical features
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Peripherally expanding, spongy, livid-red nodules with numerous pustules and fistulas; initially sieve-like aspect. Later, formation of ulcers of different sizes, covered with grease, with arcuate borders. Occasionally, superimposed, verrucous epithelial proliferates with discharge of a serous-purulent secretion on pressure. The foci can be as large as the palm of the hand. Frequently, this form of pyoderma develops as a vegetating single focus. However, multiple occurrences are possible. Such forms of pyoderma have been described, for example, in necrobiosis lipoidica or in radiation scars, i.e. in pre-damaged bradydrophic tissues.

With adequate wound management, healing occurs with the formation of irregularly configured scars. Also bridge and pinnacle scars.

External therapy
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Consistent wound management (Note: in the case of chronic pyoderma of this kind, the cause is often inadequate nursing management).

Damp compresses with disinfecting solutions such as polihexanide (Serasept, Prontoderm, Prontosan), quinolinol (e.g. Chinosol 1:1000 or R042 ).

Ointment dressings with disinfectant additives such as polyvidon iodine ointment(e.g. Betaisodona ointment).

For deeper defects, wound treatment appropriate to the stage of the wound.

Internal therapy
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Antibiotics after antibiogram.
  • Agent of choice for β-hemolytic streptococci is benzylpenicillin (penicillin G) dosage 10 million IU over 10 days. Alternatively erythromycin (e.g. erythrocin) 3 times/day 500 mg p.o., doxycyclin (e.g. Doxy Wolff) 2 times/day 100 mg p.o.
  • For staphylococcal infections cephalosporins such as cefuroxime (e.g. Elobact 2 times/day 250 mg p.o. or Flucloxacillin (e.g. Staphylex Kps.) 3-4 times/day 0.5-1.0 g p.o.

Progression/forecast
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No spontaneous regression.

Note(s)
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The vegetative (bacterial) pyoderma must be distinguished from the aetiologically unexplained clinical picture of Pyoderma gangraenosum, which may be complicated by other organ manifestations (e.g. paraproteinemia, polycythaemia vera, ulcerative colitis, etc.).

Some authors list the chancery pyoderma as an independent clinical picture. Clinically and therapeutically, however, this clinical picture differs only slightly from chronic vegetative pyoderma.

Literature
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  1. Alexis A et al (2005) Off-label dermatologic uses of anti-TNF-a therapies. J Cutan Med Surg 9: 296-302
  2. Aksu Çerman A et al (2016) Pyoderma vegetans misdiagnosed as verrucous carcinoma. Am J Dermatopathol 38:148-50.
  3. Antonelli E et al (2021) Dermatological manifestations in inflammatory bowel diseases. J Clin Med 10:364.
  4. Barrick CJ et al (2019) Necrobiosis lipoidica with superimposed pyoderma vegetans. Cutis 103:44-45.
  5. Bianchi L et al (2001) Pyoderma vegetans and ulcerative colitis. Br J Dermatol 144:1224-1247
  6. Bianchi L et al (2001) Pyoderma vegetans and ulcerative colitis. Br J Dermatol 144: 1224-1227
  7. Hallopeau H (1898) Pyodermite vegetante, its relations to dermatitis herpetiformis and pemphigus vegetans. Arch Dermatol Syph (Vienna) 43: 289-306
  8. Hornstein OP et al (1984) Pluriorificial vegetative pyoderma in T-cell deficiency. Dermatol 35: 132-137
  9. Molodoi AD et al.(2015) Pyoderma vegetans developed on chronic leg ulcer.
  10. Rev Med Chir Soc Nat Iasi 119:107-111.
  11. Rieder JM et al (2004) Pyoderma vegetans of the penis. J Urol 171: 354
  12. Shanavas S et al (2019) Pyoderma vegetans of the perineum in the setting of Ulcerative Colitis. ACG Case Rep J 6:e00170.
  13. Yu SX et al (2020) Nasal mucosa pyoderma vegetans associated with ulcerative colitis: A case report. World J Clin Cases 8:4953-4957.

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Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 11.10.2021