Phagedena: gangrenous and necrotic ulcerations of skin and subcutaneous tissue.

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.