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Erosive pustular dermatosis of the leg associated with compression bandaging and fungal infection
Author(s) -
Dawn G.,
Loney M.,
Zamiri M.,
Shaffrali F.,
Urcelay M.,
Patel M.,
Howatson S.R.,
Douglas W.S.
Publication year - 2003
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1046/j.1365-2133.2003.05094.x
Subject(s) - medicine , dermatology , leg ulcer , surgery
Summary Background Erosive pustular dermatosis of the leg (EPDL) has been described in association with venous insufficiency and atrophy of the skin of the lower leg. Like erosive pustular dermatosis of the scalp, this disease has also been reported to be a non‐infective condition. Objectives To investigate the clinicopathological features and, where possible, the aetiology of clinical EPDL. Methods We identified a group of patients undergoing continuous compression bandaging for venous dermatitis of the legs and/or predominantly venous leg ulceration with clinical features described in patients with EPDL. They were investigated by skin biopsy, patch testing and microbiological tests for the presence of bacteria and fungi. Results Twenty‐four of 400 (6%) patients were noted to have pustules on the leg(s). There was laboratory evidence of fungal infection in 13 of 24 patients (54%), with complete and sustained resolution of pustules after antifungal treatment. Pustulation in the other 11 patients (46%) was unresponsive to antibiotics for confirmed bacterial infection; some improvement was seen with potent topical corticosteroids but full clearance was achieved only after a switch from continuous four‐layer compression bandaging to the use of intermittent long stretch compression. Conclusions EPDL is a fairly common clinical picture seen in patients undergoing continuous compression bandaging. It may be produced by opportunistic, particularly fungal, infection. In almost half an infective aetiology cannot be demonstrated and a pyoderma gangrenosum‐like process may be implicated.