ECTHYMA (ecthyma; Greek ekthyma pustule) — a deep not follicular pustule or a bubble with an ulceration in the center and densely attached crust.
AA. cause streptococci, is more rare staphylococcus or staphylococcus together with streptococci (ordinary E.), in nek-ry cases the pyocyanic stick (getting, or gangrenous E.), pale treponema (syphilitic E.). To development E. the wrong care of skin, the increased perspiration, developments of stagnation in the lower extremities, decrease in the general reactivity of an organism promote (see). Ecthymas quite often arise during the combing of skin, in particular as a complication of a pruritic parasitic dermatosis (see), stings of blood-sicking insects.
The ecthyma represents the cavity located in epidermis and a derma and which is characterized by a necrosis in the field of its bottom and the inflammatory infiltrate consisting of neutrophils and lymphocytes on the periphery.
Ordinary E. begins with emergence against the background of limited inflammatory infiltrate of a bubble (see the Vesicle) or a deep (epidermo-dermalny) pustule (see); on 2 — the 3rd day contents of a pustule or a bubble shrink, forming dense layered is purulent - the necrotic crust spliced with the subject fabrics. After falling away of a crust the ulcer of rounded or irregular shape, with steep edges, slightly bleeding bottom covered with a dirty-gray plaque — an ektimatozny ulcer is found (tsvetn. tab., Art. 336, fig. 7). Later 2 — 3 weeks the ulcer heals, leaving the hem surrounded with a zone of pigmentation. Ordinary E. can be single or multiple; they are localized on skin of shins, hips, buttocks, trunks are more rare. AA. can be complicated by a lymphangitis (see) and lymphadenitis (see).
Getting E. develops at the weakened children in the first years of life, is more rare at the exhausted elderly people and differs in the considerable depth and morbidity of the formed ulcers.
Syphilitic E. — one of forms of a pustular syphilide (secondary period of syphilis). It is characterized by availability of dense infiltrate in the basis of ulcers and positive takes of a serological test (see Syphilis).
AA. it is necessary to distinguish from a skin leushmaniosis (see), an indurative tuberculosis cutis (see Tuberculosis extra pulmonary) and a chronic ulcer pyoderma (see) on the basis a wedge. manifestations and detection of the activator.
Treatment single ordinary E. consists in processing of surrounding healthy skin of 2% spirit solution salicylic to - you, imposing of bandages with ointments (2 — 3% of white mercury, 5% of streptotsidovy, 5% erythromycin); at a bad vazhivleniye apply 10% dermatolovy ointment, with an excess growth of granulations process them caustic silver. At multiple ordinary E., in case of their complication, and also at getting E. except topical treatment appoint inside antibiotics. Fortifying means (polyvitamins, iron preparations) are shown, at a sluggish current carry out an autohemotherapy (see). At syphilitic E. specific treatment is necessary.
The forecast at ordinary E. favorable, however at irrational therapy, presence of the general a disease (e.g., a diabetes mellitus) their transition to a chronic ulcer pyoderma is possible; at getting E. because of depth, extensiveness of defeat and the phenomena of a cachexia (see) the forecast can be adverse.
Prevention ordinary E. the dignity consists in early and rational treatment of superficial pustulous diseases, in purpose of fortifying therapy and observance. - a gigabyte. mode.
Bibliography: White G. B. Pustulous diseases of skin, M., 1963; Danilov L. N. To a question of a gangrenous ecthyma, Vestn. dermas. and veins., No. 12, page 55, 1978; Troitsk A. D. Piodermita (staphyloderma and streptoderma), page 73, L., 1958.
O. K. Shaposhnikov