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

• EG (Ecthyma Gangrenosum)

What is Ecthyma Gangrenosum? (Definition/Background Information)

• Ecthyma Gangrenosum (EG) is a rare and potentially life-threatening skin infection, caused predominantly by the bacterium Pseudomonas aeruginosa, and to a lesser extent by other bacterial, fungal, or viral pathogens
• The condition is typically observed in immunocompromised individuals, or those who are terminally ill. It is termed as a medical emergency, necessitating urgent treatment and support
• Ecthyma Gangrenosum results in the formation of skin lesions that quickly bleed and ulcerate. The skin ulcers can develop on any part of the body, but chiefly affects the groin region, around the genitals and anus
• Examination of the fluid drainage under microscope and culture of affected tissue specimen and imaging techniques may be employed to diagnose Ecthyma Gangrenosum
• Prolonged treatment with antibiotics (if the cause is bacterial) may be necessary to remove the infection. In some cases, the abscess may be surgically drained or surgically debrided. Debridement involves removing infected, dead (necrotic) tissue that will never recover or heal. It helps topical therapy reach and improve the healthier deeper layer of skin and other tissues.
• However, the prognosis of Ecthyma Gangrenosum is typically guarded. It mostly depends on the severity of infection, the promptness in providing treatment, and the response of the patient to treatment

Who gets Ecthyma Gangrenosum? (Age and Sex Distribution)

• Ecthyma Gangrenosum can affect individuals of any age group, although infants and elderly adults are more prone to this form of infection
• Both male and female genders are affected and no preference is seen
• It is a rare bacterial infection that is observed worldwide. All racial and ethnic groups are at risk

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

All individuals with a weak immunity exposed to the causative bacteria may be at an elevated risk. The following are some known risk factors for Ecthyma Gangrenosum (EG):

• Severe and extensive burns
• Malnutrition
• Certain pre-existing conditions such as uncontrolled diabetes
• Compromised immunity owing to HIV/AIDS, organ transplantation, chemotherapy or radiation therapy
• Many cases of EG have been associated with septicemia (a serious form of blood infection)
• Premature and otherwise compromised newborn children

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 Gangrenosum? (Etiology)

Ecthyma Gangrenosum (EG) is normally caused by Pseudomonas aeruginosa bacterium, which is present latently in most humans.

• However, the bacteria remain inactive, since healthy humans have a strong immune system. In those who have a highly-vulnerable or compromised immune system, P. aeruginosa gets activated causing infection
• This uncommon condition can also be caused by other bacterial pathogens including Escherichia coli, Proteus sp., Klebsiella pneumoniae, and methicillin-resistant Staphylococcus epidermidis (MRSE). Other species of Pseudomonas bacteria are also known to cause EG to a much lesser extent
• Apart from the above, fungal infections involving Candida albicans and Aspergilllus sp., and viral infections involving herpes simplex virus (HSV), have also been implicated as causing Ecthyma Gangrenosum

What are the Signs and Symptoms of Ecthyma Gangrenosum?

The signs and symptoms of Ecthyma Gangrenosum may include the following:

• Presence of fluid-filled skin blisters (pustules) at various body sites, which are usually painless
• Bleeding and skin ulceration (necrosis of tissue) is noted early in the disease (in some cases, within a few hours)
• Some of the ulcers are small, while others can be quite large. The size may range from 1-15 cm
• In most cases, multiple lesions are observed; while in some cases, a solitary lesion is observed
• Generally, fever and diarrhea are observed prior to the development of the skin lesions

The body sites commonly affected include the anogenital area and the armpits. However, other areas, such as the trunk, limbs, groin, and rarely, the face, may be affected.

How is Ecthyma Gangrenosum Diagnosed?

Ecthyma Gangrenosum is diagnosed based on the following tests and exams:

• A thorough physical examination and assessment of symptoms
• Evaluation of the affected individual’s medical history
• Imaging studies of affected areas to determine extent of the infection of soft tissue in the area of ulceration
• Blood tests including complete blood count (CBC)
• Culture of blood, fluid, or tissue from the infected area
• 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
  • Polyarteritis nodosa
  • Necrotizing fasciitis
  • Anthrax
  • Fungal infections
  • Pyoderma gangrenosum

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 Gangrenosum?

The following are some potential complications from Ecthyma Gangrenosum:

• Formation of large lesions
• The infection spreading to other organs away from the primary site of infection
• Healing of the lesions with scars 
• Septicemia or infection of blood
• Disfigurement causing cosmetic concerns and emotional stress

How is Ecthyma Gangrenosum Treated?

The treatment measures for Ecthyma Gangrenosum may include:

• Administration of antibiotics including penicillin, aminoglycosides, or fluoroquinolones, or a combination of the same, when Pseudomonas aeruginosa is the cause of infection
• Administration of antifungal or antiviral medications, based on the specific cause of Ecthyma Gangrenosum
• Surgical drainage of abscess; draining the abscess by inserting a needle
• Surgical removal of infected tissue (debridement): Surgery is sometimes necessary for cases in which large abscesses have developed, the infection has spread to organs and bones, and antibiotics alone are unsatisfactory
• Surgical removal of the lesion, if it does not respond to medications
• Treating the underlying cause of immunosuppression

How can Ecthyma Gangrenosum be Prevented?

Ecthyma Gangrenosum can be prevented through adherence to the following factors:

• Practicing proper hygiene: Maintaining hygiene (washing hands regularly) and keeping skin injury sites
• Avoiding the use of commonly shared items, such as for preparation of food and drink
• Use of proper disposal techniques while handling tissues, diapers, other contaminated items; washing hands thoroughly, after disposing contaminated items
• Educate the immunocompromised patients and create an awareness of possible conditions, to enable them to be better prepared and seek timely medical treatment

Completing the full course of prescribed antibiotics regimen, to eliminate the infection causing bacteria from deep tissue, as well as to prevent relapse of infection.

What is the Prognosis of Ecthyma Gangrenosum? (Outcomes/Resolutions)

The prognosis of Ecthyma Gangrenosum depends on the overall health condition of the affected individual and his/her response to medical treatment. The prognosis can only be ascertained on a case-by-case basis. Nevertheless, a poorer outcome is dictated by the following factors:

• Presence of multiple skin lesions
• Delayed diagnosis and treatment
• Poor response to treatment

According to medical reports, the mortality rate is high without sufficient treatment (up to 50%).

Additional and Relevant Useful Information for Ecthyma Gangrenosum:

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.