Dawn G, Loney M, Zamiri M, Shaffrali F, Urcelay M, Patel M, Howatson S R, Douglas W S
Departments of Dermatology and Pathology, Monklands Hospital, Airdrie, Lanarkshire ML6 0JS, UK.
Br J Dermatol. 2003 Mar;148(3):489-92. doi: 10.1046/j.1365-2133.2003.05094.x.
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.
To investigate the clinicopathological features and, where possible, the aetiology of clinical EPDL.
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.
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.
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.
腿部糜烂性脓疱性皮炎（EPDL）已被描述为与静脉功能不全及小腿皮肤萎缩相关。与头皮糜烂性脓疱性皮炎一样，该疾病也被报道为非感染性疾病。
研究临床EPDL的临床病理特征，并尽可能探究其病因。
我们确定了一组因腿部静脉性皮炎和/或主要为静脉性腿部溃疡而接受持续加压包扎的患者，这些患者具有EPDL患者所描述的临床特征。对他们进行了皮肤活检、斑贴试验以及细菌和真菌微生物学检测。
400例患者中有24例（6%）腿部出现脓疱。24例患者中有13例（54%）有真菌感染的实验室证据，抗真菌治疗后脓疱完全且持续消退。其他11例患者（46%）的脓疱对确诊的细菌感染使用抗生素无反应；强效外用糖皮质激素治疗后有一定改善，但仅在从持续四层加压包扎改为使用间歇性长拉伸加压后脓疱才完全消退。
EPDL是在接受持续加压包扎的患者中常见的临床表现。它可能由机会性感染，尤其是真菌感染引起。近半数病例无法证实感染病因，可能涉及坏疽性脓皮病样过程。
