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Phagedena: gangrenous and necrotic ulcerations of skin and subcutaneous tissue
Abstract:
Phagedena is an old term for serious deep, necrotic and gangrenous skin ulcers. In the past these have been regarded as severe infections. A review of 31 cases revealed that except in cases of Streptococcus pyogenes or Clostridium welchii infection a bacterial of fungal infection was only one of several factors that led to the development of phagedenic ulcers. Initiating factors may be a bacterial infection, a debilitated state as a result of immunosuppressive therapy or of such conditions as alcoholism, severe diabetes, inflammatory bowel disease or severe arteriosclerosis, and various types of injury or trauma. Continuing factors include enzymatic mechanisms, the release of toxins from large areas of dead tissue and vascular disorders. In general, antibiotics are of limited value. systemic corticosteroid therapy may be useful in the subacute or chronic case. In acute, spreading, gangrenous phagedena with surrounding erythema, fever and systemic toxic effects, immediate excision of dead tissue may be lifesaving.
Insights
Phagedena, severe necrotic skin ulcers, often result from multiple factors beyond infection. Management requires addressing underlying conditions and may involve corticosteroids or surgical intervention for acute cases.
Area of Science:
- Dermatology
- Infectious Diseases
- Vascular Surgery
Background:
- Phagedena is an archaic term for severe, necrotic, and gangrenous skin ulcers, historically attributed solely to infection.
- A review of 31 cases indicates that bacterial or fungal infections are often only one component in the multifactorial etiology of phagedenic ulcers.
Purpose of the Study:
- To elucidate the complex etiology of phagedenic ulcers.
- To evaluate the efficacy of various treatment modalities for phagedenic ulcers.
Main Methods:
- Review of 31 case studies of phagedena.
- Analysis of initiating and continuing factors contributing to ulcer development.
- Assessment of treatment outcomes including antibiotic therapy, corticosteroid use, and surgical intervention.
Main Results:
- Bacterial or fungal infections were not the sole cause in most phagedena cases, except for Streptococcus pyogenes or Clostridium welchii.
- Initiating factors include infections, debilitated states (immunosuppression, alcoholism, diabetes, inflammatory bowel disease, arteriosclerosis), and trauma.
- Continuing factors involve enzymatic activity, toxin release from necrotic tissue, and vascular disorders.
Conclusions:
- Phagedenic ulcers result from a complex interplay of factors, with infection being only one element.
- Antibiotics have limited efficacy; systemic corticosteroids may benefit subacute/chronic cases.
- Immediate surgical excision of necrotic tissue is crucial for acute, spreading, gangrenous phagedena with systemic toxicity.