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Ecthyma in Adult
Other Resources UpToDate PubMed

Ecthyma in Adult

Contributors: Noah Craft MD, PhD, Lindy P. Fox MD, Susan Burgin MD
Other Resources UpToDate PubMed


Ecthyma is an ulcerative bacterial skin infection caused by group A beta-hemolytic streptococci and often secondarily associated with staphylococci. As ecthyma often begins superficially and extends into the dermis, it is often referred to as a deeper form of impetigo. Unlike impetigo, which only affects the stratum corneum, ecthyma extends into the dermis and results in a scar.

Clinically, the lesions of ecthyma appear as vesicles or pustules that ulcerate and crust over. The lower extremities are sites of predilection.

Immunosuppression, poor hygiene, overcrowding, malnutrition, humidity, and pre-existing trauma to the tissues all predispose one to infection. It has also been seen on the lower legs of military trainees in tropical climates. It is more common at the extremes of age.


L08.0 – Pyoderma

762694009 – Ecthyma

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • The disorder is similar to streptococcal Nonbullous impetigo but is differentiated by deeper components.
  • Ecthyma should be differentiated from Ecthyma gangrenosum, which is caused by Pseudomonas sepsis and is potentially life threatening and evolves over hours to days.
  • CA-MRSA skin infection
  • Pyoderma gangrenosum
  • Mycobacterium marinum infection infection
  • Cutaneous leishmaniasis
  • Arthropod bite or sting
  • Sporotrichosis
  • Lymphomatoid papulosis
  • Papulonecrotic tuberculid
  • Tungiasis
  • Stasis ulcer or Ischemic ulcer
  • Yaws
  • Haemophilus ducreyi cutaneous ulcers (see Chancroid)

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Last Reviewed:08/21/2019
Last Updated:07/18/2023
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Ecthyma in Adult
A medical illustration showing key findings of Ecthyma : Buttocks, Crust, Skin ulcer, Lower legs, Thighs
Clinical image of Ecthyma - imageId=52771. Click to open in gallery.  caption: 'A close-up of a large eroded, ulcerated, and crusted plaque.'
A close-up of a large eroded, ulcerated, and crusted plaque.
Copyright © 2024 VisualDx®. All rights reserved.