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Location: areas most affected are the buttocks, thighs, legs, ankle and feet.

Symptoms: Echtyma begins as a moderately painful vesicle or pustule overlying an inflamed area of skin that deepens into a dermal ulceration with overlying gray-yellow crust that is thicker and harder than the crust of impetigo. When adherent crust is removed a shallow, punched-out ulceration is apparent. The deep dermal ulcer has a raised and indurated surrounding margin. Unlike impetigo, ecthyma can sometimes result in scarring.

Echtyma is often referred to as a deeper form of impetigo as the same bacteria causing the infection are involved but ecthyma causes deeper erosions of the skin, the infection goes through the outer layer of skin (epidermis) and into the deeper layer (dermis). It usually arises on the lower extremities of children, persons who are immunocompromised (with diabetes, neutropenia) and neglected elderly patients. Ecthyma can be seen in areas of previously sustained tissue injury (eg, excoriations, insect bites, dermatitis). Factors affecting the development of ecthyma are: high temperature and humidity; crowded living conditions and poor hygiene.

Treatments: Improved nutritional status and two to three weeks of treatment with a beta-lactamase resistant antibiotic are usually required to bring about resolution of the lesions. Warm soaks (using a cloth soaked in warm tap water) are helpful for removing crusts. Antiseptic soap or peroxide washes of the lesion may be helpful in hastening recovery.

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