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• W4376875765 abstract "A 40-year-old female with a history of methamphetamine use, alcohol use, and homelessness presented with a painful and pruritic skin lesion of the left thigh. Symptom onset was 2 weeks prior with skin erythema and blister formation which subsequently transitioned to an ulcerative scale, localized surrounding erythema, and central area of exudate without fluctuance. She had previously had similar lesions on her extremities and under breast folds, which resolved spontaneously. She denied intravenous drug use, sick contacts, recent travel, animal exposures, history of HIV, or diabetes. She denied fever, chills, and shortness of breath or other systemic symptoms. Ecthyma is an ulcerative pyoderma (also known as “adult impetigo”) that will typically present as a skin and soft tissue infection involving the epidermis and dermis.1 This is in contrast to the variation of impetigo seen primarily in children that typically involves the epidermis alone.1 The most common organisms are group A Streptococcus species with community Methicillin-resistant Staphlococcus aureus (MRSA) becoming more prevalent.2 Alternatively, ecthyma gangrenosum is a rare severe systemic illness usually caused by Pseudomonas species and presents with hemorrhagic bullae.2, 3 A viral (parapoxvirus) zoonotic ecthyma, Orf disease, can be transmitted from handling goats and sheep. These present with painful vesicular lesions that ulcerate, then spontaneously resolve.3, 4 Ulceroglandular tularemia would be considered with tick bite or woodland animal exposures, and clinically could be differentiated with presence of lymphadenopathy and systemic symptoms such as fever.5 Cutaneous or injection anthrax tends to be painless and forms a necrotic, black, eschar after initial blistering rash and potential systemic symptoms.6 Diagnosis is made typically by history and exam alone. These lesions are contagious by skin-to-skin contact and are most common in congregate living or those with impaired hygiene.1 Management with debridement, topical antibiotics, and antiseptics alone is appropriate with local wound care measures early in course with return precautions.2 Skin lesions normally resolve in 2–3 weeks and 20% of lesions resolve spontaneously.1, 3 Oral antibiotics are recommended if there are signs of multiple skin lesions, history of congregate living, signs of deeper soft tissue involvement, or systemic symptoms as they can decrease length of illness and spread.2 For refractory cases, dermatology referral and skin biopsy advised.3 Tetanus prophylaxis should be considered for both open wounds and those wounds at risk for contamination.7 (See Figure 1)" @default.
• W4376875765 created "2023-05-18" @default.
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• W4376875765 date "2023-05-16" @default.
• W4376875765 modified "2023-10-14" @default.
• W4376875765 title "Adult female with a painful and pruritic lower extremity skin lesion" @default.
• W4376875765 cites W2064339333 @default.
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• W4376875765 doi "https://doi.org/10.1002/emp2.12967" @default.
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