Pyoderma vegetating L08.0

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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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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Chronic, therapy-resistant pyoderma, which can occur after banal injuries. Frequently occurring in immunocompromised patients or as a consequence of a therapy-resistant leg ulcer.

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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Located mainly on the extremities, especially on the lower legs, the backs of the feet and hands.

Clinical features
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Peripherally expanding, spongy, livid-red infiltrates with numerous pustules and fistulas; initially a screen-like aspect. Later development of differently sized, smearily covered ulcers with arch-shaped margins. Occasionally, superimposed, verrucous epithelial proliferates are also formed with evacuation of a serous-purulent secretion under pressure. The foci can become as large as the palm of the hand. Often this form of pyoderma develops as a vegetative single focus. Multiple occurrence is possible.

With adequate wound management, healing takes place with the formation of irregularly configured scars. Also bridge and tip 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. Aksu Çerman A et al (2016) Pyoderma Vegetans Misdiagnosed as Verrucous Carcinoma.
    At J Dermatopathol 38:148-50.
  2. Bianchi L et al (2001) Pyoderma vegetans and ulcerative colitis. Br J Dermatol 144: 1224-1227
  3. Hallopeau H (1898) Pyodermite vegetante, its relationship to dermatitis herpetiformis and pemphigus vegetans. Arch Dermatol Syph (Vienna) 43: 289-306
  4. Hornstein OP et al. (1984) Pluriorificative vegetative pyoderma with T-cell defect. dermatologist 35: 132-137
  5. Molodoi AD et al(2015) Pyoderma vegetans developed on chronic leg ulcer.
    Rev Med Chir Soc Med Nat Iasi 119:107-111.
  6. Rieder JM et al. (2004) Pyoderma vegetans of the penis. J Urol 171: 354

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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: 29.10.2020