What are the other Names for this Condition? (Also known as/Synonyms)

• Deeper Form of Impetigo

What is Ecthyma? (Definition/Background Information)

• Ecthyma is a common skin condition that is typically caused by a bacterial infection. It results in the formation of skin ulcers, commonly in the lower limbs
• It is considered to be a form of impetigo that affects the deeper skin tissues. Impetigo is a contagious skin infection, which causes red and itchy patches on skin that are fluid-filled and painless
• Ecthyma is normally caused by the bacterium Staphylococcus aureus or Streptococcus pyogenes. It is a common condition in young children, older adults, and immunocompromised individuals
• A diagnosis of Ecthyma requires a physical exam and culture of the fluid and pus oozing from the sore, for the presence of the causative bacteria. Antibiotics are the mainstay of treatment for Ecthyma. Also, maintaining personal hygiene and cleanliness is important in early resolution of the condition 
• The prognosis of Ecthyma can be good with early diagnosis and adequate treatment. The prognosis also depends on certain factors that include the severity of infection and immune status of the affected individual

Who gets Ecthyma? (Age and Sex Distribution)

• Ecthyma may affect individuals of any age; although, young children and elderly adults are more prone to the condition
• It affects both males and females without any predilection
• Also, there is no preference for any racial or ethnic group observed, and the condition is seen worldwide

What are the Risk Factors for Ecthyma? (Predisposing Factors)

The risk factors associated with Ecthyma may include:

• Older adults with diabetes and individuals with weak immune systems are more susceptible to developing Ecthyma
• Children less than 6 years of age (because their immune system is in the developing stage)
• Scabies: A skin condition caused by parasitic mites
• Pre-existing wounds
• Insect bites
• Poorly-controlled diabetes
• HIV infection
• Poverty, poor standards of living, and overcrowded conditions/settlements
• Malnutrition, especially among children
• Use of medication that can suppress the immune system
• Direct contact with an infected individual; sharing towels, bed, and clothes of individuals with the skin condition
• The presence of pre-existing chronic dermatitis (inflammation of skin) can increase the risk
• Any condition that causes a weak or poor immunity (such as organ transplant or chronic illness)
• Severe impetigo that does not respond to treatment, or when treatment is not adequately provided

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Ecthyma? (Etiology)

• The common cause of Ecthyma is infection by two types of bacteria, namely Staphylococcus aureus and Streptococcus pyogenes
• The infection occurs in the deeper tissues/layers of the skin. Typically, these bacteria enter the human skin through open cuts and wounds

What are the Signs and Symptoms of Ecthyma?

The signs and symptoms of Ecthyma may include:

• The presence of skin sores (vesicles) which rupture and ooze pus
• The lesion penetrates deeper into the second layer of the skin
• Following ulceration, the skin lesion develops an overlying yellow crust
• The size of the lesion can range in size from 0.5 to 3 cm
• Small lesions may increase in size over time
• Itching and pain may be felt

Ecthyma lesions are commonly observed in the lower extremities. It may involve the buttocks, thigh, leg, knee, ankle, and feet.

How is Ecthyma Diagnosed?

The diagnosis of Ecthyma may involve the following tests and exams:

• Complete evaluation of medical history along with a thorough physical exam, including examination of the skin sores and blisters
• Blood or wound culture: A culture may be performed to confirm the presence of bacteria and to rule-out other causes of infection. In this culture, a small amount of pus or fluid from one of the sores is collected and sent to the lab for testing. The test results can help confirm the presence and type of bacteria (if any)
• Skin biopsy: A skin biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis
• Differential diagnosis of the following skin conditions or infections presenting similar symptoms should be ruled out:
  • Ecthyma gangrenosum
  • Rickettsial infection
  • Skin infection by mycobacterium sp.
  • Insect bites
  • Anthrax
  • Leishmaniasis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Ecthyma?

The complications of Ecthyma may include:

• Formation of scars upon healing of the skin lesions
• Lightening (hypopigmentation) or darkening (hyperpigmentation) of the skin following resolution of the condition
• Emotional stress due to cosmetic concerns
• Gangrene formation in the lesions, if severe skin ulcers are left untreated. This can be an emergency medical situation
• Enlarged regional lymph nodes (lymphadenopathy) that may be painful
• Systemic infection, when the whole body is involved/affected
• Recurrence of the condition

How is Ecthyma Treated?

The treatment measures for Ecthyma may include:

• Employing hygienic measures, such as keeping the skin clean
• The areas around the blisters should be gently washed with soap and running water. Moist yellow scabs can be cleansed with hydrogen peroxide diluted (1/1) with water
• Topical antibiotics, such as ointments mupirocin and retapamulin, prescribed by the physician can be applied to the affected areas
• Oral antibiotics are prescribed for widespread infection and intravenous antibiotics for severe infections. The entire course of medication prescribed by the healthcare provider should be completed for effective cure and prevention of recurrence
• Covering the affected areas with gauze or loose bandage, helps in reducing the risk of further infection spread

How can Ecthyma be Prevented?

Following are some of the precautionary measures for preventing Ecthyma:

• Always keeping the skin clean and healthy
• Cuts, scrapes, insect bites, and wounds must be washed immediately and antibiotic ointment applied to prevent further spread of the infection
• Ecthyma sores should be washed with soap and running water. The affected area should be covered lightly with gauze to prevent the spread of infection
• Wearing gloves while applying ointment on the blisters is advised. Washing the hands after applying ointment on the blisters is recommended
• Items used by the infected individual, such as towels, clothing, bed, etc., should be washed or cleaned everyday
• Avoid sharing clothes, towels, bed, and any other item of the infected individuals
• Infected children’s nails should be cut short so that further infection from scratching the blisters can be avoided
• Application of soothing solutions (calamine or oatmeal-based) on the lesions may reduce itchiness
• Frequent washing of hands
• The infected child or adult is best advised to stay indoors, until he/she recovers fully
• Getting treatment for any underlying medical condition(s) that may decrease immunity in the individual

What is Prognosis of Ecthyma? (Outcomes/Resolutions)

• The prognosis of Ecthyma is good with appropriate and prompt treatment. However, the prognosis also depends upon the severity of the infection, overall health status of the individual, and the patient’s response to treatment
• Individuals with an underlying immune deficiency disorder, the elderly, and very young children may be affected the most

Additional and Relevant Useful Information for Ecthyma:

Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition. Care must be taken avoid strong soaps and chemicals that could potentially worsen the condition.