Erosive pustular dermatosis of the leg associated with compression bandaging and fungal infection.
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.


OBJECTIVE
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.
Dawn
G
G
Departments of Dermatology and Pathology, Monklands Hospital, Airdrie, Lanarkshire ML6 0JS, UK.
Loney
M
M
Zamiri
M
M
Shaffrali
F
F
Urcelay
M
M
Patel
M
M
Howatson
S R
SR
Douglas
W S
WS
D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000008:administration & dosage; D001458:Bandages; D002176:Candida albicans / Q000302:isolation & purification; D003881:Dermatomycoses / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D005260:Female; D006801:Humans; D007868:Leg Dermatoses / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009281:Naphthalenes / Q000008:administration & dosage; D010328:Patch Tests; D013211:Staphylococcus aureus / Q000302:isolation & purification; D000077291:Terbinafine; D016896:Treatment Outcome; D014249:Trichophyton / Q000302:isolation & purification
D000935:Antifungal Agents; D009281:Naphthalenes; D000077291:Terbinafine