Chronic ulcerative-vegetative pyoderma is a deep purulent—inflammatory skin disease caused by staphylo-streptococcal infection and manifested by the formation of long-existing ulcerative defects with vegetative growths on the periphery. Diagnosis of chronic ulcerative-vegetative pyoderma consists in carrying out an examination, examination of the separated ulcers with the determination of the causative agent of the disease, detection of concomitant diseases and immune disorders. Treatment includes antibiotic therapy, immunocorrection, therapy of concomitant diseases, local antibacterial, proteolytic and healing therapy, laser and UHF treatment.
The most common chronic ulcerative-vegetative pyoderma occurs at the age of 40 to 60 years. Men are more susceptible to morbidity than women. Chronic ulcerative-vegetative pyoderma refers to deep forms of pyoderma with a mixed nature of the causative agents that caused it. As a rule, this is a streptococcal infection and Staphylococcus aureus. The disease can occur as a complication of long-term folliculitis or advanced streptococcal impetigo.
The development of chronic ulcerative-vegetative pyoderma is associated on the one hand with the special virulence of the bacteria causing it, and on the other — with a weakened state of the body. The latter may be due to:
- diabetes mellitus;
- HIV infection;
- exhaustion as a result of anorexia;
- diseases of the gastrointestinal tract (peptic ulcer of the 12p. intestine, chronic gastritis, pancreatitis, hepatitis, ulcerative colitis, etc.);
- vitamin deficiency;
- decreased immunity;
- vascular pathology (atherosclerosis, varicose veins, lymphedema).
Chronic ulcerative-vegetative pyoderma begins with the formation of a deep infiltrate or boil, which quickly transforms into a large ulcer. The process is multiple in nature and is localized most often on the lower extremities. It is typical for a long course, which can be delayed for several years.
Ulcerative defects in chronic ulcerative-vegetative pyoderma are lined with sluggish granulations and are characterized by a large amount of purulent discharge, which is accompanied by an unpleasant odor. Tissue overgrowth along the periphery of the ulcer — vegetation is typical. Around the lesion there is swelling and redness of the skin, there is a rash of deep pustules. Ulcerative defects tend to increase in diameter and spread deep into the tissues, affecting not only the dermis and subcutaneous tissue, but also muscles. Involvement of the underlying bone in the purulent process leads to the development of osteomyelitis.
Chronic ulcerative-vegetative pyoderma is accompanied by common symptoms: malaise, severe soreness, sleep disorders, the development of anemia. The healing of ulcerative defects occurs with the formation of rough scars. Separately, there are chancriform pyoderma, which has a similarity to solid chancre, and serpiginous pyoderma, which is characterized by a combination of healing processes in the center of the ulcer with ongoing inflammation on its periphery.
The diagnosis is carried out by a dermatologist on the basis of an examination, anamnestic data, and the results of back-sowing of the separated ulcers. Histological examination in chronic ulcerative-vegetative pyoderma reveals signs of chronic inflammation of the dermis with necrotic and granulomatous foci, dystrophic changes in the epidermis. Anemia is often noted in the blood test. According to the indications, a coprogram is carried out, a stool analysis for dysbiosis, a study of blood sugar and pancreatic enzymes, an ultrasound of the abdominal cavity, an immunogram. In case of chancriform pyoderma, microscopy of the separated ulcers for pale treponema, PCR diagnostics and RPR test are required.
To diagnose concomitant somatic diseases, a consultation of a gastroenterologist and an immunologist is prescribed, if necessary, a vascular surgeon. Differential diagnosis of chronic ulcerative-vegetative pyoderma is carried out with:
- vegetative pemphigus;
- deep forms of fungal diseases;
- tertiary syphilis;
- ulcerative-vegetative manifestations of tuberculosis.
Chronic ulcerative-vegetative pyoderma is an indication for systemic antibiotic therapy. Antibiotics are used in accordance with the data of the antibioticogram and are combined with immunostimulating therapy (gamma globulin, antistaphylococcal plasma). According to the results of the immunogram, immunomodulators are prescribed. A good effect is given by the use of a drug with flavonoids of wild cereals in complex therapy, which stimulates the production of interferon in the body. At the same time, correction of existing somatic disorders should be carried out.
In the general treatment of chronic ulcerative-vegetative pyoderma, ointments with glucocorticosteroids and antibiotics, proteolytic enzymes, Vishnevsky ointment, silver nitrate, dermatol ointment, means for accelerated epithelialization are used. Laser therapy, UHF, local UFO therapy is carried out.