Ecthyma

Thisdisease is described as consisting of isolated phlyzacious pustules - namely, those which are "large, raised on a hard base, of a vivid red color, and succeeded by thick, hard, dark-colored scabs, beneath which there is ulceration." The pustules are generally distinct, round, and isolated; they are mostly general, but may be partial, and leave cicatrices behind. The shoulders, buttocks, and limbs are parts usually attacked. There aretwo chief forms described - acute and chronic.

Acute general ecthyma is rare. The ordinary scattered ecthyma is practically always the result of the action of some irritant upon the skin, in an unhealthy or badly nourished subject; and so ecthymatous pustules frequently occur in connection with scabies and phtheiriasis, and more rarely in pruri, or eczema, and other diseases.

Acute ecthyma commences with slight febrile disturbances, and occasionally sore throat; locally, there is first a. sense of heat and burning, followed by the appearance of reddish raised points, with hard, indurated bases, and distinct vivid areolae; these points, which vafy in size from that of a pea to that of a shilling, quickly pustulate, and are often accompanied by acute, sharp pain. In two or three days the pustules give exit to discharge, which dries into hard, adherent, dirty, discolored scabs, covering over circular ulcerations; the crusts fall off in a week or so, leaving behind dark stains. The ecthymatous spots may be few or many; in the latter case a good deal of irritation is set up; the patient may be unable to sleep from pain, and the glands and lymphatic vessels may become inflamed, small abscesses forming subsequently. The disease is generally protracted by successive crops of pustules, or it may relapse into a chronic state. Thelimbs, shoulders, and trunk are chief seats of the disease.


Chronic ecthyma generally results from the action of some irritation, as in scabies, in connection with pediculi, and from scratching and badly nourished subjects. The ecthvmatous pustules in the chronic disease are of similar character to those of acute ecthyma. They are painful, with hard, inflammatory bases and a small central collection of pus. When they occur on the limbs, especially the legs, in old people they are followed sometimes by troublesome ulcers.

In ecthyma the seat of disease appears to be the uppermost layer of the derma, not unlikely about the glands of the skin, the depth of surface involved being less than in funmculus, and there is no "core", otherwise ecthyma would be well classed with boils. The tendency to ulceration and sloughing, the lividity of the inflammatory areola, the disturbance of the general system, all point to a cachec­tic condition.