Skip to main content
NCBI home page
Canadian Medical Association Journal logoLink to Canadian Medical Association Journal
. 1982 Feb 15;126(4):363–368.

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

R Jackson, M Bell
PMCID: PMC1862891  PMID: 7066792

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.

Full text

PDF
363

Images in this article

364FIG. 2
on p.364
364FIG. 3
on p.364
365FIG. 4
on p.365
367FIG. 5
on p.367
367FIG. 6
on p.367
367FIG. 7
on p.367

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aaronson C. M. Postoperative abdominal wall necrosis. Med Ann Dist Columbia. 1973 Apr;42(4):176–179. [PubMed] [Google Scholar]
  2. Brenner D. E., Lookingbill D. P. Serratia marcescens cellulitis. Arch Dermatol. 1977 Nov;113(11):1599–1600. [PubMed] [Google Scholar]
  3. COLLINS R. N., NADEL M. S. GANGRENE DUE TO THE HEMOLYTIC STREPTOCOCCUS--A RARE BUT TREATABLE DISEASE. N Engl J Med. 1965 Mar 18;272:578–580. doi: 10.1056/NEJM196503182721109. [DOI] [PubMed] [Google Scholar]
  4. Callen J. P., Taylor W. B. Pyoderma gangrenosum--a literature review. Cutis. 1978 Jan;21(1):61–64. [PubMed] [Google Scholar]
  5. Fast M., Woerner S., Bowman W., Christie K., Schroeder M., Albritton W. Ecthyma gangrenosum. Can Med Assoc J. 1979 Feb 3;120(3):332–334. [PMC free article] [PubMed] [Google Scholar]
  6. File T. M., Jr, Marina O. A., Flowers F. P. Necrotic skin lesions associated with disseminated candidiasis. Arch Dermatol. 1979 Feb;115(2):214–215. [PubMed] [Google Scholar]
  7. Giuliano A., Lewis F., Jr, Hadley K., Blaisdell F. W. Bacteriology of necrotizing fasciitis. Am J Surg. 1977 Jul;134(1):52–57. doi: 10.1016/0002-9610(77)90283-5. [DOI] [PubMed] [Google Scholar]
  8. Himi A., Ishizaki H., Okada T. Dermatitis gangrenosa infantum. J Dermatol. 1977 Apr;4(2):69–71. doi: 10.1111/j.1346-8138.1977.tb01014.x. [DOI] [PubMed] [Google Scholar]
  9. Holder I. A., Haidaris C. G. Experimental studies of the pathogenesis of infections due to Pseudomonas aeruginosa: extracellular protease and elastase as in vivo virulence factors. Can J Microbiol. 1979 May;25(5):593–599. doi: 10.1139/m79-085. [DOI] [PubMed] [Google Scholar]
  10. Hutchinson P. E., Summerly R., Lawson L. J. Postoperative progressive gangrene: a reminder. Br J Dermatol. 1976 Jan;94(1):89–95. doi: 10.1111/j.1365-2133.1976.tb04348.x. [DOI] [PubMed] [Google Scholar]
  11. Kinmont P. D., McCallum D. I. Haemorrhagic and necrotic leg ulcers in the elderly. Australas J Dermatol. 1967 Dec;9(2):95–112. doi: 10.1111/j.1440-0960.1967.tb01292.x. [DOI] [PubMed] [Google Scholar]
  12. Kirby J. D., Marriott P. J. Skin necrosis following warfarin therapy. Br J Dermatol. 1976 Jan;94(1):97–99. doi: 10.1111/j.1365-2133.1976.tb04349.x. [DOI] [PubMed] [Google Scholar]
  13. Koehn G. G. Necrotizing fasciitis. Arch Dermatol. 1978 Apr;114(4):581–583. [PubMed] [Google Scholar]
  14. Ledingham I. M., Tehrani M. A. Diagnosis, clinical course and treatment of acute dermal gangrene. Br J Surg. 1975 May;62(5):364–372. doi: 10.1002/bjs.1800620510. [DOI] [PubMed] [Google Scholar]
  15. Lyerly D., Kreger A. Purification and characterization of a Serratia marcescens metalloprotease. Infect Immun. 1979 May;24(2):411–421. doi: 10.1128/iai.24.2.411-421.1979. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Michaels L., Buttoo A. S., Hills P. Fulminating hemolytic streptococcal infection. Can J Surg. 1969 Jul;12(3):318–325. [PubMed] [Google Scholar]
  17. Moschella S. L. The clinical significance of necrosis of the skin. Med Clin North Am. 1969 Mar;53(2):259–274. [PubMed] [Google Scholar]
  18. Perry H. O. Pyoderma gangrenosum. South Med J. 1969 Aug;62(8):899–908. doi: 10.1097/00007611-196908000-00001. [DOI] [PubMed] [Google Scholar]
  19. Rea W. J., Wyrick W. J., Jr Necrotizing fasciitis. Ann Surg. 1970 Dec;172(6):957–964. doi: 10.1097/00000658-197012000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Singh S., Lynfield Y. L., Gruber H. Fournier's gangrene of the scrotum. Int J Dermatol. 1975 Sep;14(7):508–509. doi: 10.1111/j.1365-4362.1975.tb04288.x. [DOI] [PubMed] [Google Scholar]
  21. Tehrani M. A., Ledingham I. M. Necrotizing fasciitis. Postgrad Med J. 1977 May;53(619):237–242. doi: 10.1136/pgmj.53.619.237. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Wilson C. B., Siber G. R., O'Brien T. F., Morgan A. P. Phycomycotic gangrenous cellulitis. A report of two cases and a review of the literature. Arch Surg. 1976 May;111(5):532–538. doi: 10.1001/archsurg.1976.01360230032005. [DOI] [PubMed] [Google Scholar]
  23. Yu V. L. Serratia marcescens: historical perspective and clinical review. N Engl J Med. 1979 Apr 19;300(16):887–893. doi: 10.1056/NEJM197904193001604. [DOI] [PubMed] [Google Scholar]

Articles from Canadian Medical Association Journal are provided here courtesy of Canadian Medical Association

RESOURCES