title: Ecthyma gangrenosum versus ecthyma-like lesions: should we separate these conditions?
abstract: BACKGROUND
  We analyzed cases of ecthyma gangrenosum (EG) and "ecthyma-like" or "ecthyma-mimicking" cases of necrotic lesions of the skin to improve current definitions of these conditions.
  
  
  METHODS
  The retrospective analysis compared 28 cases of lesions (from 2001 to June 2015) that were identified as EG. Age, sex, lesion location, time from macule to ulcer, underlying diseases, number of lesions per patient, wound bacterial culture, blood culture, and immune status served as variables for analysis and comparison.
  
  
  RESULTS
  Only in 20 cases (71.42%) was Pseudomonas aeruginosa the etiology of the lesion. The etiology of eight cases was various bacterial species (five cases, 17.85%) and fungal species (three cases, 10.73%). In 21 cases (75%), the lesion appeared in immunocompromised patients. In four cases (14.28%), the patients suffered from Pseudomonas sepsis. In four cases (14.28%), the lesion appeared in healthy individuals. There was no difference in clinical picture, lesion location, number of lesions per person, and treatment strategy between Pseudomonas and non-Pseudomonas cases.
  
  
  CONCLUSIONS
  Necrotic lesions resembling EG can have various microbiological etiology and can occur in immunocompetent or healthy persons. With no difference in clinical picture, two separate definitions should not be applied to Pseudomonas and non-Pseudomonas cases. We suggest accepting a broader definition of EG.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Assaf Harofe Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Corresponding author: vaimed@yahoo.com.
authors.forename: Michael
authors.initials: M
authors.lastname: Vaiman
authors.affiliation: Department of Microbiology, Assaf Harofe Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Tsilia
authors.initials: T
authors.lastname: Lasarovitch
authors.affiliation: Department of Plastic Surgery, Assaf Harofe Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Lior
authors.initials: L
authors.lastname: Heller
authors.affiliation: Pediatric Surgery Department, Assaf Harofe Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Gad
authors.initials: G
authors.lastname: Lotan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004473:Ecthyma / Q000097:blood / Q000382:microbiology / Q000473:pathology*; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D011552:Pseudomonas Infections / Q000097:blood / Q000382:microbiology / Q000473:pathology*; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification*; D012189:Retrospective Studies; D012867:Skin / Q000382:microbiology / Q000473:pathology*; D055815:Young Adult