Pyoderma: Difference between revisions

Revision as of 14:26, 20 November 2014

1/100,000 people per year in US, primarily 40s-50s yoa
Dysfunction of activated neutrophils
>50% associated with systemic disease:
- IBD
- Polyarthritis, sero-negative and -positive
- Leukemia
- Less commonly psoriatic arthritis, OA, RA, spondyloarthopathy, hepatitis, PBC, myelomas, SLE, Sjogren

Extracutaneous manifestations (due to sterile neutrophilic infiltrates)
- Culture-negative pulmonary infiltrates most common
- CV, CNS, GI, eyes, liver, spleen, bones, LNs
Features
- Initial lesion - bite-like, small, red papule or pustule (many patients attribute spider bite)
- Changes into larger, ulcerative lesion
- Two primary variants:
  - Classic ulcerative form - usually on legs, deep ulceration, violaceous border along ulcer bed
  - Superficial, atypical form - hands/forearms/face, vesiculopustular
- Less common variants: 1) Peristomal pyoderma, 2) Genital pyoderma (must differentiate from STI), 3) Pyostomatitis vegetans (intraoral)

Papules
- Insect bites
- Scabies
- Seabather's eruption
- Cercarial dermatitis (Swimmer's Itch)
Macular
- Chikungunya
Sub Q Swelling and Nodules
Ulcers
- Tropical pyoderma
- Leishmaniasis
- Mycobacterium marinum
- Buruli ulcer
- Dracunculiasis (Guinea Worm disease)
Linear and Migratory Lesions
- Cutaneous larvae migrans
- Photodermatitis

See also domestic U.S. ectoparasites

Authors:

@@ Line 21: / Line 21: @@
 ==Differential Diagnosis==
+*Pyoderma is Dx of exclusion
+*Systemic diseases
+**Neutrophilic dermatoses (Sweet, Behcet, etc.)
+**Calciphylaxis - very important to differentiate due to Tx
+**Arterial/venous insufficiency
+**Blastomycosis
+**Hidradenitis suppurative
+**TB gumma, mycobacterial infections
+**Malignancy (squamous cell)
+**Vasculitis
+**Ecthyma gangrenosum (pseudomonas)
 {{Travel Skin Conditions DDX}}