Ectima: Causes, Risk Factors, Symptoms, Diagnosis, Treatment, Complications and Prognosis

It is a common and benign skin condition that is usually caused by a bacterial dermohypodermic infection.

It results in the formation of ulcers on the skin, commonly in the lower extremities.

It is considered as a form of impetigo that affects the deeper tissues of the skin.


Ecthyma is usually caused by the bacteria Staphylococcus aureus or Streptococcus pyogenes.

It is a common condition in young children, older adults and immunocompromised people.

The infection occurs in the deeper tissues or layers of the skin.

Usually, these bacteria enter human skin through open cuts and wounds.

Risk factor’s

Risk factors associated with Ectima may include:

  • Older adults who suffer from poorly controlled diabetes.
  • Children under 6 years old, since their immune system is in the development stage.
  • The presence of scabies, a condition of the skin caused by microscopic mites.
  • The presence of chronic dermatitis (inflammation of the skin) wounds, insect bites, among others.
  • Low socio-economic strata, conditions of critical poverty, overcrowded settlements.
  • Malnutrition , especially in the case of children.
  • Direct contact with an infected person; share towels, linens and clothes of people with skin condition.
  • Any condition that causes a suppression of the immune system . As the use of medications after an organ transplant or chronic disease such as HIV.
  • Severe impetigo that when the treatment is not adequately provided or the patient does not respond to the treatment.

A risk factor increases the chances of getting a disease, compared to an individual who does not have the risk factors. Some risk factors are more important than others.


Signs and symptoms of Ectima may include:

  • It is characterized by lesions in the form of vesicles or pustules that rupture early and suppurate pus.
  • The lesion penetrates deeper into the second layer of the skin.
  • After ulceration, the lesion of the skin develops well delimited, like punching, with edges of violet tones with the necrotic bottom and an overlying yellow scab.
  • The size of the lesion can vary in size, the ulceration is from 0.5 to three centimeters in diameter.
  • They can cause itching and pain.

Ecthyma lesions are commonly observed in the lower extremities.

It can involve the buttocks, the thigh, the legs, the knees, the ankle and the feet.


The diagnosis of Ectima may involve:

  1. Complete evaluation of the clinical history: A thorough physical examination, which includes the examination of skin lesions and blisters.
  2. Cultivation of tissue or wound fluids: A culture can be performed to confirm the presence of bacteria and rule out other causes of infection. In this culture, a small amount of pus or fluid is collected from one of the sores and sent to the laboratory for analysis.
  3. Skin biopsy: A skin biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After gathering the clinical findings, the special studies on the tissues and the findings of the microscope, a definitive diagnosis is achieved.

A differential diagnosis should be made for the following skin conditions or infections that have similar symptoms:

  • Ectima gangrenoso.
  • Rickettsia infection.
  • Skin infection by Mycobacterium sp.
  • Insect bites infected.
  • Anthrax.
  • Leishmaniasis.


Treatment measures for Ectima may include:

  • Use hygienic measures, such as keeping the skin clean.
  • The areas around the blisters should be washed gently with soap and running water. Wet and yellow crusts can be cleaned with hydrogen peroxide diluted with water.
  • Topical antibiotics, such as copper sulfate, iodochlorohydroxyquinoline (clioquinol), mupirocin, or sodium fusidate (fusidic acid).
  • Oral antibiotics are prescribed for disseminated infections and intravenous antibiotics for serious infections such as: dicloxacillin , amoxicillin with clavulanic acid, cephalexin , azithromycin , clindamycin, procaine penicillin G, benzathine penicillin, erythromycin or tetracycline.
  • Covering affected areas with gauze or loose bandages helps reduce the risk of spreading additional infections.

Antibiotics are the basis of treatment for Ectima. In addition, maintaining personal hygiene and cleanliness is important for early resolution of the condition.


Complications of Ectima may include:

  • Formation of scars after the resolution of skin lesions.
  • Lightening (hypopigmentation) or darkening (hyperpigmentation) of the skin after resolution of the condition.
  • Gangrene formation in lesions, if severe skin ulcers are not treated. This may be an emergency medical situation in diabetic patients.
  • Enlarged regional lymph nodes (lymphadenopathy) that can be painful.
  • Systemic infection, when the whole body is involved or affected.
  • Recurrence of the condition.


The prognosis of Ectima can be good with an early diagnosis and an adequate treatment.

But, it also depends on certain factors that include the severity of the infection, the immune status of the affected individual and the patient’s response to the treatment.

People with an underlying immune deficiency disorder, the elderly and very young children may be more affected.


The following are some of the precautionary measures to prevent Ectima:

  • Keep the skin clean and healthy.
  • Cuts, scrapes, insect bites and wounds should be washed immediately and an antibiotic ointment applied to prevent further spread of the infection.
  • Ecthyma sores should be washed with running water and soap. The affected area should be covered lightly with gauze to prevent the spread of the infection.
  • It is recommended to wear gloves while applying an ointment on the ampoules and to wash your hands after applying ointment on the blisters.
  • Items used by the infected person, such as towels, clothes, bed, etc., should be washed or cleaned every day.
  • Avoid sharing clothes, towels, bedding and any other items of infected people.
  • The nails of infected children should be cut to avoid further infection by scratching the blisters.
  • The application of soothing solutions, such as those based on calamine or oats, in lesions can reduce itching.
  • Receive treatment for any underlying medical condition that may decrease the immunity in the individual.
  • Cleaning the skin too hard with chemicals or soaps can aggravate the condition of the skin.