Summary about Disease
Ecthyma is a severe skin infection that's a deeper form of impetigo. It's characterized by ulcerative sores with a thick, crusted surface, often on the lower extremities (legs, ankles, feet). These sores penetrate deeper into the dermis than impetigo, leading to scarring upon healing.
Symptoms
Pus-filled blisters or vesicles that turn into ulcers.
Thick, hard crust or scab covering the ulcer. The crust is typically greyish-yellow or brown-black.
Redness and inflammation around the ulcer.
Pain or tenderness at the site of the infection.
Possible swollen lymph nodes in the affected area.
Often, ecthyma lesions develop on the legs and buttocks.
Causes
Most commonly caused by Streptococcus pyogenes* (group A strep).
Less frequently caused by Staphylococcus aureus.
Poor hygiene.
Minor skin injuries or abrasions that allow bacteria to enter.
Underlying conditions like diabetes, immunocompromised states (HIV/AIDS, etc.), or malnutrition can increase risk.
Neglected impetigo can sometimes progress to ecthyma.
Medicine Used
Oral antibiotics: Typically, a course of oral antibiotics is prescribed to eradicate the bacterial infection. Common antibiotics used include penicillin, cephalexin, dicloxacillin, or clindamycin. The choice of antibiotic depends on the likely causative bacteria and local resistance patterns.
Topical antibiotics: While not usually sufficient alone for ecthyma, topical antibiotics like mupirocin or retapamulin may be used as adjunctive therapy, particularly if there are smaller satellite lesions.
Pain relievers: Over-the-counter pain relievers like acetaminophen or ibuprofen can help manage pain and discomfort.
Is Communicable
Yes, ecthyma is communicable. It can spread through direct contact with the sores or discharge from the sores. Indirect contact via contaminated objects (towels, clothing) can also transmit the bacteria.
Precautions
Good hygiene: Wash hands frequently with soap and water, especially after touching the affected area.
Keep the area clean: Gently wash the sores with soap and water and pat dry.
Cover the sores: Cover the sores with a clean, dry bandage to prevent spreading the infection.
Avoid touching or scratching: Avoid touching or scratching the sores to prevent further irritation and spread of the bacteria.
Wash contaminated items: Wash clothing, towels, and bedding that have come into contact with the sores in hot water with detergent.
Avoid sharing personal items: Do not share towels, clothing, razors, or other personal items with others.
Keep fingernails short and clean: This will help prevent scratching and spreading the infection.
Complete antibiotic course: Take all antibiotics as prescribed, even if the sores appear to be healing.
How long does an outbreak last?
With appropriate antibiotic treatment, ecthyma typically starts to improve within a few days. However, complete healing can take several weeks (2-4 weeks or longer), depending on the size and depth of the ulcers and the individual's overall health. Without treatment, the infection can persist for a more extended period and potentially lead to complications.
How is it diagnosed?
Clinical examination: Diagnosis is usually made based on the characteristic appearance of the ulcers and crusts.
Bacterial culture: A swab of the ulcer can be taken for bacterial culture to identify the specific bacteria causing the infection and determine antibiotic sensitivities. This helps guide appropriate antibiotic therapy.
Rule out other conditions: In some cases, a biopsy may be performed to rule out other conditions that can cause similar skin lesions.
Timeline of Symptoms
1. Initial lesion: Begins as a small, red, pus-filled blister or vesicle. 2. Ulcer formation: The blister ruptures, forming an ulcer that extends deeper into the skin. 3. Crust formation: A thick, hard crust develops over the ulcer. 4. Progression: The ulcer may slowly enlarge if untreated. 5. Healing: With appropriate treatment, the ulcer will gradually heal, but scarring is common.
Important Considerations
Ecthyma requires prompt medical attention and antibiotic treatment to prevent complications and scarring.
Individuals with underlying medical conditions (diabetes, immunocompromise) are at higher risk for ecthyma and may require more aggressive treatment.
It's important to differentiate ecthyma from other skin conditions, such as ecthyma gangrenosum (caused by Pseudomonas aeruginosa), which requires a different treatment approach.
Educate patients and caregivers about proper wound care, hygiene, and infection control measures to prevent recurrence and spread of the infection.