Pyoderma: Difference between revisions
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==Workup== | ==Workup== | ||
*No specific criteria | |||
*Labs | |||
**CBC, CMP, UA, hepatitis profile | |||
**Tissue cultures (comprehensive, all organisms) | |||
**VDRL | |||
**ANCA | |||
**Coags | |||
**Anti-phospholipid AB | |||
**Referral for heme malignancy w/u | |||
**Referral for IBD | |||
*Imaging - CXR if systemic disease suspected | |||
==Management== | ==Management== | ||
Revision as of 14:28, 20 November 2014
Background
- 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
Clinical Features
- 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)
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)
- Papules
- Insect bites
- Scabies
- Seabather's eruption
- Cercarial dermatitis (Swimmer's Itch)
- Macular
- 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
Workup
- No specific criteria
- Labs
- CBC, CMP, UA, hepatitis profile
- Tissue cultures (comprehensive, all organisms)
- VDRL
- ANCA
- Coags
- Anti-phospholipid AB
- Referral for heme malignancy w/u
- Referral for IBD
- Imaging - CXR if systemic disease suspected