Ecthyma

Dear Dr. Rockoff,

I am concerned that I have Ecthyma. I have an appointment with a dermatologist in September. I am worried that I may have some immune system problem because from what I have read it seems very unusual for adults to have Ecthyma without a compromised immune system.

I realize that it is probably nearly impossible to determine whether I have Ecthyma over the internet but here is a short summary of my symptoms:

1) Three months ago three lesions formed on my right arm and front of my upper chest. These started out as small red bumps which I scratched which caused them to ulcerate. Once ulcerated they had the characteristic look of Ecthyma (punched out center red border). The all grew to around .75cm. These took about a month and half to heal and all left red bumps after healing. They have shrunk but still seem quite red.

2) Two months ago two small lesions appeared on my left elbow. These didn’t grow as large as the other lesions but they look similar and have taken a long time to heal and have left behind two small hard bumps.

3) Last week two new lesions appeared on my left thigh and calf. The one on my thigh is larger at about 1cm diameter. This lesion looks a lot like photos of Ecthyma. Punched out center and red border.
None of these lesions hurt that much. While these lesions appeared I tried to check my lymph nodes for swelling but I can’t seem to determine whether they were swollen.

Does Ecthyma appear without underlying immunity problems or is it usually an indicator of something more serious ( ie HIV, diabetes)?

Thanks

[Alan Rockoff, MD]

You are correct to say that it is impossible for me to diagnose ecthyma over the internet.  Is it possible that these punched-out ulcers are coming about because of your squeezing or exploring them?  If so, you should stop doing this.  The fact that some of these lesions have healed over on their own speaks strongly against the possibility of ecthyma, because serious bacterial infections don't take care of themselves, even short-term.  Your best bet is just to let things be, physically and intellectually, until you see the dermatologist, who can presumably set you straight.

Best.

Dr. Rockoff