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Dermatitis Factitia and Pyoderma Gangrenosum. Presented by Herbert Mescon, MD.
A 28-year-old white man had a generalized dermatosis for 16 months. A small blister appeared on his right foot in May 1971 and gradually enlarged, opened, and crusted. Fungus infection was diagnosed, but cultures were negative. Penicillin was administered orally and other local and systemic therapy was prescribed, but there was no improvement. Examination revealed generalized, discrete, coinshaped areas of dusky erythema and fine scaling, most marked on the back, chest, and face (Fig 1). Many of these lesions had central crusting, and when the crust was removed, an area of sharply outlined central ulceration remained. A large crusted lesion was present on the bridge of the nose. On the right foot, there was a large, well-demarcated area of ulceration, exuberant granulation tissue, and necrotic debris covering almost the entire plantar surface and extending to the dorsum of the foot and ankle (Fig 2 and 3).
Schiff BL, Kern AB. NEW ENGLAND DERMATOLOGICAL SOCIETY. Arch Dermatol. 1973;108(1):126. doi:10.1001/archderm.1973.01620220084025