Chancriform pyoderma is an atypical purulent–inflammatory skin lesion characterized by the similarity of clinical manifestations with syphilitic solid chancre, which is reflected in the name. The symptom of this disease is the development of a single ulcer (rarely multiple formations), most often localized in the genital area or on the red border of the lips, chin, neck. Diagnosis of chancriform pyoderma is performed by serological and microbiological methods, an auxiliary role is also played by general clinical blood tests, dermatological examination. Treatment of this pathology is carried out with antibiotics, antiseptics, antimicrobials.
General information
Chancriform pyoderma is a rare dermatological disease of a purulent-inflammatory nature, which refers to chronic ulcerative streptostaphyloderma (mixed pyoderma). This pathology was first described in 1934 by Hoffmann, who noted the significant similarity of its clinical manifestations with solid chancre in syphilis. In some cases, this circumstance led to incorrect diagnosis and, as a consequence, to incorrect treatment of chancriform pyoderma. This form of streptostaphyloderma is quite rare, it affects both men and women with the same frequency.
In clinical dermatology, chancriform pyoderma refers to atypical varieties of deep purulent-inflammatory skin lesions, which also include ulcerative-vegetative pyoderma and pyogenic granuloma. The disease can appear at any age, an important role in its development is played by a decrease in the activity of immunity and the presence of other purulent lesions of the skin or other organs.
Causes
The causative agents of chancriform pyoderma are representatives of mixed microflora – most often Staphylococcus aureus and various representatives of streptococci are detected in ulcers. Ways of penetration:
- through micro-injuries of the skin, abrasions (including scratching with scabies or other diseases accompanied by itching);
- in rare cases, infection may be introduced by hematogenic route.
Predisposing factors to the development of this pathology are a decrease in the activity of the immune system as a result of diabetes, malnutrition, debilitating diseases. In men, chancriform pyoderma develops more often against the background of phimosis. Facilitates infection by non-compliance with the rules of personal hygiene.
Pathogenesis
After penetration into the tissues, bacteria begin to multiply rapidly, inflammation occurs, which ultimately leads to a characteristic clinical picture of the disease. To date, the reasons why the purulent-inflammatory process in the case of pyoderma chancriforme proceeds in this way are reliably unknown – presumably, this is due to the peculiarities of the reactivity of the body. A clear relationship between this disease and certain groups of microorganisms could not be identified. For this reason, chancriform pyoderma refers to atypical purulent-inflammatory skin lesions.
Symptoms
Chancriform pyoderma can occur in both men and women of different ages. Most often, the inflammatory process manifests itself in the genital area (on the head of the penis and foreskin in men, labia and vagina in women), but occasionally another localization is possible. Cases of the development of chancriform pyoderma on the lips, chin, neck, oral mucosa are described. Most often, this pathology occurs against the background of other dermatological or general diseases that contribute to a decrease in immunity (for example, diabetes mellitus) or facilitating infection (other forms of pyoderma, scabies).
Initially, with chancriform pyoderma, a bubble of 0.5-2 centimeters in size filled with serous contents forms on the surface of the skin. Quite quickly (often in the first hours after formation), it collapses, exposing the erosive bottom, in place of which an ulcer with a diameter of 1-2 centimeters then develops. No subjective symptoms (itching, soreness, burning) this formation in case of chancriform pyoderma does not have, which will give it an additional similarity with solid chancre. The bottom of the ulcer is clean bright pink or covered with dark crusts, there is a purulent or hemorrhagic discharge. A narrow inflammatory rim may be defined around it.
Of the other manifestations of chancriform pyoderma, the presence of a dense infiltrate in the skin located under the ulcer, regional lymphadenitis, and sometimes an increase in temperature may occur is most often noted. Lymphadenitis is manifested by an increase in regional lymph nodes (inguinal, cervical), their soreness during palpation, but they are not soldered to the surrounding tissues and among themselves. An increase in temperature with chancriform pyoderma is extremely rare, fever may indicate a complication of the disease – the addition of sepsis, metastatic transfer of the pathogen with the development of abscesses in internal organs.
Diagnostics
Diagnosis of chancriform pyoderma is mainly reduced to the determination of the causative agent of this disease and the exclusion of syphilis. For this purpose, serological, microbiological and dermatological research methods are used. Wasserman’s reaction in chancriform pyoderma is negative, during microbiological examination of the discharge from ulcers, there are no pale treponemas, but only staphylococci and streptococci are contained.
A dermatologist on examination reveals an ulcer, localized most often in the genital area, when questioned, it turns out that there are no subjective symptoms. Histological examination (with chancriform pyoderma is performed only with erased and unclear symptoms) reveals pronounced edema of the dermis, acanthosis, diffuse infiltration, consisting mainly of neutrophils and lymphocytes.
Treatment
It is permissible to start treatment of pyoderma chancriforme only after accurate and reliable confirmation of the diagnosis and exclusion of syphilis. Both local antiseptic and antibacterial agents in the form of ointments and solutions, and systemic antibiotics are used.
- Most often, penicillins, macrolides, tetracyclines are used for the disease, and sulfonamides are used from other antimicrobial agents. For the greatest effectiveness of antimicrobial therapy in chancriform pyoderma, it is necessary to conduct tests for the sensitivity of pathogens to various antibiotics at the diagnostic stage.
- It is important to increase the level of immunity, therefore, vitamins, immunostimulants are used in the treatment of patients, normalize the diet and sleep regime.
- Solutions of aniline dyes, chlorhexidine are locally prescribed, solutions and ointments based on zinc hyaluronate and biogenic stimulants are prescribed to accelerate healing and epithelialization.
- Physiotherapeutic methods of treatment (UVI of the affected area, microwave heating) also leads to faster healing of ulcers with chancriform pyoderma.
Prognosis and prevention
The prognosis for chancriform pyoderma is usually favorable – with properly prescribed treatment, the purulent-inflammatory process fades, and erosion heals. At the same time, in the case of its development, a more or less noticeable scar may remain on the skin, whereas when localized on the mucous membranes, the ulcer heals without a trace. The prognosis of chancriform pyoderma worsens in the presence of immunodeficiency, diabetes mellitus and other similar conditions – in these cases, the treatment of pathology takes a long time, and the risk of complications increases: new ulcers, other forms of pyoderma, sepsis.
For the prevention of chancriform pyoderma, one should adhere to the rules of personal hygiene, maintain an optimal level of immunity, timely detect and treat diseases that contribute to the development of this condition.
