Biopsy may help identify early pyoderma faciale (rosacea fulminans)

Pyoderma faciale is an uncommon acute presentation of rosacea. Edema, nodules, and draining sinuses may occur. Women in their early 20s are typically affected, and severe scarring may result in untreated cases. We report the case of a woman in whom a biopsy helped establish an early diagnosis so that decisive intervention could be initiated and scarring avoided. The histologic features of pyoderma faciale only rarely have been described and are illustrated in this case.

[Diagnostic image (268). A man with 'pyodermia' in the beard area]

A 61-year-old man developed tinea barbae (kerion barbae) caused by Trichophyton mentagrophytes varietas interdigitale following prolonged intensive care treatment for septic shock and meningitis. Whenever a suppurative folliculitis develops, fungal infection is a possible cause.

Blastomycosis-like pyoderma: Successful treatment with low-dose acitretin

Blastomycosis-like pyoderma typically presents as verrucous plaque(s) with a purulent discharge through multiple sinuses. Two patients with blastomycosis-like pyoderma developing on significantly sun-damaged skin are presented: an 84-year-old man with multiple painful nodules and plaques, and a 92-year-old woman with a solitary plaque on the left calf. Histopathology showed pseudoepitheliomatous hyperplasia with dermal foci of suppuration. Staphylococcus aureus was isolated from a biopsy specimen in the first patient, whereas the latter patient had Prevotella and Corynebacterium species. Investigations for fungi and mycobacteria yielded negative results. These microbiological findings further supported the clinicopathological diagnosis. Both patients failed to respond to oral doxycycline despite the in vitro susceptibility of the organisms. Treatment with low-dose oral acitretin was successful in both patients after 3-4 months.

A prospective study of the clinical findings, treatment and histopathology of 44 cases of pyotraumatic dermatitis

Pyotraumatic dermatitis (hot spot) is a common clinical syndrome in dogs but there are few prospective scientific studies related to it. The aim of this study was to investigate correlations among clinical pyotraumatic dermatitis, histopathology of the lesions and possible predisposing causes. The relationship of these with breed, age, sex and location of lesion was assessed statistically. A clinical diagnosis of acute pyotraumatic dermatitis was made in 44 privately owned dogs. Males exceeded females (P = 0.0348) and lesions were more common in dogs aged 4 years or less (P < 0.0001). Lesions were most often seen on the cheek, neck and lateral thigh with a significant correlation between breed and site of lesion (P < 0.0001). In 31 cases a possible underlying cause was found or suspected. In contrast to previous studies, no otitis externa was recorded and the study was conducted in an area without endemic fleas. Fourteen breeds were represented of which Rottweiler, German shepherd dog and golden retriever were most common. There was no significant seasonal incidence and no correlation among site of lesion and cause, time of year, age or sex. Histopathologically, the dogs could be separated into four patterns by the presence or absence of eosinophils and/or folliculitis. Eosinophils have not previously been recorded in pyotraumatic dermatitis but were seen in 29 cases. Acute folliculitis was seen in 20 cases. However, no correlation was seen among age, sex, breed, underlying cause or site of lesion and histopathology. Twenty-seven cases were cultured for bacteria of which 25 grew Staphylococcus intermedius and two were negative.

A retrospective study comparing the histopathological features and response to treatment in two canine nasal dermatoses, DLE and MCP

Canine discoid lupus erythematosus (DLE) and mucocutaneous pyoderma (MCP) have overlapping clinical and histopathological changes, often making diagnosis difficult. Histopathological features of 27 nasal planum biopsies were scored to determine whether DLE and MCP were histopathologically distinguishable. Long-term follow-up, enabling assessment of clinical diagnoses, was available on 15 cases; 11/15 cases were immunomodulatory responsive (ImR) and 4/15 were antibiotic responsive (AbR). Clinical diagnosis, determined by response to treatment for 15/27 cases, was not predictable based on scoring of histopathological features. Distinct histopathological patterns were observed: 2/11 ImR cases had a lymphocyte-rich interface dermatitis. All other cases had the same histopathological changes: a band-like diffuse superficial plasmacytic to lymphoplasmacytic dermatitis +/- focal basal cell damage, but different clinical diagnoses (4/4 AbR, 9/11 ImR). German shepherd dogs/crosses were over-represented (44.4% of the cases) and tended to have more multifocal lesions (41.7% vs. 26.7% of all other breeds). Longer duration of disease was associated with a preponderance of plasmacytic infiltrate (P = 0.026).

Localized blastomycosis-like pyoderma with good response to cotrimoxazol and cryotherapy

Blastomycosis-like pyoderma is an unusual, exaggerated, vegetative-tissue reaction to a prolonged primary or secondary bacterial infection. It is a rare disease, usually seen in immunocompromized patients. We report a case of localized blastomycosis-like pyoderma responding poorly to classic treatments, but that gave a dramatic response to a combination treatment of cotrimoxazol and cryotherapy.

Pyodermatitis-pyostomatitis vegetans with circulating autoantibodies to bullous pemphigoid antigen 230

We describe a woman from Korea with pyodermatitis-pyostomatitis vegetans associated with ulcerative colitis. On immunofluorescence examination, she demonstrated in vivo bound and circulating IgG antibasement membrane zone antibodies. The immunoelectron microscopy and immunoblot analysis showed that the antibodies reacted with the bullous pemphigoid antigen 230. We consider that the circulating autoantibodies to the bullous pemphigoid antigen 230 in this patient were an epiphenomenon, resulting from epidermal damage induced by inflammation of pyodermatitis-pyostomatitis vegetans.

Cutaneous Wegener's granulomatosis (malignant pyoderma) in a patient with Crohn's disease

We report a case of an unusual presentation of Wegener's granulomatosis (WG) in a patient with Crohn's disease (CD). She presented to our Wound Care Center with 7th cranial nerve palsy and facial pyoderma-like ulcerations. Although WG has a predilection for the lung, kidney, and eyes, cutaneous involvement can be seen in 50% of the cases, and it can be the presenting sign in 9-14%. Because of the lethality of WG if not properly treated, the diagnosis is imperative.

Tinea capitis in adult women masquerading as bacterial pyoderma

Tinea capitis is generally thought to be a common disease in children but not in adults. Adults with tinea capitis generally present with scale and alopecia. We report 3 adults with inflammatory tinea capitis caused by Trichophyton tonsurans that resembled a bacterial infection. Of these patients, 2 were initially given a diagnosis of bacterial pyoderma. All patients were successfully treated with oral antifungal agents. One patient had significant eosinophilia that resolved with treatment. We conclude that tinea capitis should remain in the differential diagnosis of adults with alopecia and pyoderma-like presentations. A biopsy specimen was helpful in making the diagnosis in 2 of the 3 patients, but fungal culture confirmed the diagnosis in all cases.

Effects of an ethyl lactate shampoo in conjunction with a systemic antibiotic in the treatment of canine superficial bacterial pyoderma in an open-label, nonplacebo-controlled study

An open-label, nonplacebo-controlled study was designed to compare systemic cephalexin therapy versus systemic cephalexin and ethyl lactate shampoo therapy in the treatment of canine superficial bacterial pyoderma. Twenty client-owned dogs diagnosed with generalized superficial bacterial pyoderma (SP) were alternately assigned to oral treatment with cephalexin (25 to 30 mg/kg every 12 hours) or treatment with cephalexin (as for Group 1) and twice-weekly shampooing with a 10% ethyl lactate shampoo, which was left in contact with the dog's skin for 10 minutes. On Days 14 and 28, skin lesion severity scores, assessed by the investigators, were significantly (P <.01) lower for the group treated with cephalexin and shampoo than for the group treated with cephalexin only. On Day 14, dog owners gave better scores to dogs treated with cephalexin and shampoo for haircoat appearance and body odor than for dogs treated only with cephalexin. Clinical and cytologic resolution of SP occurred significantly (P <.02) sooner in the cephalexin/shampoo group (29.4 days) than in the cephalexin only group (37.8 days).

Ideal skin grafting for pyodermia chronica

Three cases of pyodermia chronica were successfully treated with ideal split-thickness skin grafts. This method offers appropriate wound coverage after radical surgical excision in cases of extensive pyodermia chronica.

Superficial granulomatous pyoderma: an idiopathic granulomatous cutaneous ulceration

A 70-year-old male with a superficial granulomatous ulcer is reported. Histopathological findings were the same as those described for superficial granulomatous pyoderma, a recognized variant of classic pyoderma gangrenosum. The differences between pyoderma gangrenosum and its variant superficial granulomatous pyoderma are highlighted.