Pyoderma vegetating L08.0

Hallopeau 1898; Nanta and Bazex 1937

Increasingly rarely used, only vaguely defined term for a "chronic, fistulating, peripherally progressing, therapy-resistant skin infection(pyoderma)", which can occur after trivial injuries, but then does not resolve as usual, but develops a chronic momentum of its own. Such chronic, also fistulizing pyodermas are mainly found in immunocompromised patients.

Such vegetating skin suppurations can also occur in the wake of a therapy-resistant leg ulcer. The distinction from pyoderma gangraenosum appears to be "fluid", especially since the occurrence of vegetating pyoderma, like pyoderma gangraenosum, has been described in ulcerative colitis (Bianchi L et al. 2001).

Mostly beta-hemolytic group A streptococci or Staphylococcus aureus. More rarely, gram-negative germs or a mixed flora trigger the infection (Molodoi AD et al. 2015).

Defects in humoral or cellular immunity (see immunodeficiencies below), predisposing local factors, virulent pathogens, superinfection of an underlying skin lesion.

Localized mainly on the extremities, especially on the lower legs.

Expanding peripherally, spongy, livid red erythema, plaques, red nodules with numerous pustules and fistulas; initially sieve-like aspect. Later, formation of ulcers of various sizes, covered with smear, with scalloped borders. Occasionally, superimposed verrucous epithelial proliferates with discharge of a serous-purulent secretion on pressure. The foci may be as large as the palm of the hand. Frequently, this form of pyoderma develops as a vegetating single focus. Multiple occurrences are rare but possible. Such forms of pyoderma have been described, for example, on the floor of a necrobiosis lipoidica or in radiation scars, i.e. in pre-damaged bradydrophic tissues.

With adequate wound management, healing occurs with the formation of irregularly configured scars. Also bridge and pinnacle scars.

Pyoderma gangraenosum

Bromoderm

deep mycoses

Actinomycosis

Sporotrichosis

Nocardiosis

Papillomatosis cutis carcinoides

Ulcerated basal cell carcinoma.

Consistent wound management (note: inadequate care management is often the cause of such chronic pyoderma).

Moist dressings with disinfectant solutions such as polihexanide (Serasept, Prontoderm, Prontosan), quinolinol (e.g. Chinosol 1:1000 or R042 ).

Ointment dressings with disinfecting additives such as polyvidone-iodine ointment (e.g. Betaisodona ointment).

In the case of deeper defects, wound treatment according to stage, if necessary covering of the skin defect by means of a graft.

• 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.

Some authors list chancroid pyoderma as an independent clinical picture.

Vegetative (bacterial) pyoderma should be distinguished from the multifactorial clinical picture of pyoderma gangraenosum, in which complicating organ manifestations (e.g., paraproteinemia, polycythaemia vera, ulcerative colitis, etc.) may be causative. Clinically and therapeutically, pyoderma gangraenosum differs only slightly from chronic vegetative pyoderma.

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2. Aksu Çerman A et al (2016) Pyoderma vegetans misdiagnosed as verrucous carcinoma. Am J Dermatopathol 38:148-50.
3. Antonelli E et al (2021) Dermatological manifestations in inflammatory bowel diseases. J Clin Med 10:364.
4. Barrick CJ et al (2019) Necrobiosis lipoidica with superimposed pyoderma vegetans. Cutis 103:44-45.
5. Bianchi L et al (2001) Pyoderma vegetans and ulcerative colitis. Br J Dermatol 144:1224-1247
6. Bianchi L et al (2001) Pyoderma vegetans and ulcerative colitis. Br J Dermatol 144: 1224-1227
7. Hallopeau H (1898) Pyodermite vegetante, its relations to dermatitis herpetiformis and pemphigus vegetans. Arch Dermatol Syph (Vienna) 43: 289-306
8. Hornstein OP et al (1984) Pluriorificial vegetative pyoderma in T-cell deficiency. Dermatol 35: 132-137
9. Molodoi AD et al.(2015) Pyoderma vegetans developed on chronic leg ulcer.
10. Rev Med Chir Soc Nat Iasi 119:107-111.
11. Rieder JM et al (2004) Pyoderma vegetans of the penis. J Urol 171: 354
12. Shanavas S et al (2019) Pyoderma vegetans of the perineum in the setting of Ulcerative Colitis. ACG Case Rep J 6:e00170.
13. Yu SX et al (2020) Nasal mucosa pyoderma vegetans associated with ulcerative colitis: A case report. World J Clin Cases 8:4953-4957.