Chronic ulcerative-vegetative pyoderma: causes, symptoms, diagnosis, treatment

Chronic ulcerative vegetative pyoderma is a deep form of pyoderma caused by streptococcal and staphylococcal infections. It occurs in people of any age. The development of the disease is facilitated by severe immunodeficiency conditions, leading to a decrease in the body's defenses, and a violation of the normal functional state of the skin.

Symptoms of chronic ulcerative vegetative pyoderma. The disease develops at the site of pustules or folliculitis. The lesion is slightly raised and sharply demarcated from the surrounding healthy skin, bluish-red in color, soft in consistency, oval in shape. On the surface of such a plaque there is an ulcer with uneven undermined edges, sluggish granulation and serous-purulent dense plaque (ulcerative form). Over time, the bottom of the ulcerative defect becomes covered with vegetations with an unpleasant-smelling serous-purulent discharge (ulcerative vegetative form). The skin around the lesion is inflamed, follicular and perifollicular superficial pustules can be seen on it, in places merging into continuous lesions. The skin pathological process can spread to the periphery (serpiginous form), capturing new areas of the skin. The disease is accompanied by pain and limited movement in the limbs. When the process regresses, the vegetations in the center of the ulcerative defect flatten out and the discharge stops. Healing occurs by forming a scar. The lesions can be single or multiple.

Histopathology. Dystrophic changes in the epidermis and chronic inflammation in the dermis with granulomatous foci, necrosis and abscess formation are noted. Lymphocytes, fibroblasts with an admixture of neutrophils, eosinophils and plasma cells predominate among the infiltrate cells.

Differential diagnosis. The disease should be distinguished from warty and colliquative tuberculosis of the skin, deep mycoses (blastomycosis, sporotrichosis).

Treatment of chronic ulcerative vegetative pyoderma. It is necessary to determine the sensitivity of the microorganism to antibiotics and prescribe antibiotic therapy. Syspres (ciprofloxacin) is effective; it is prescribed at 500 mg (for children - 250 mg) 2 times a day for one week. Immunomodulators, corticosteroids, and vitamin preparations should be added to the antibiotic therapy. To potentiate the effect of antibiotics, it is recommended to use Phlogenzym, 2 tablets 3 times a day. To increase the non-specific resistance of the body and enhance the production of alpha and gamma interferon, Proteflazit is used (20 drops 2 times a day). Proteolytic enzymes, 5% dermatol ointment, creams and ointments containing antibiotics and corticosteroids (Gentriderm, Triderm, etc.) are applied to the ulcers. The effectiveness of the therapy increases with the use of a helium-neon laser.

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