A 69-year-old male patient that had been fitted with a rigid transtibial prosthesis in 1970 presented due to progressive edema that was mildly painful on palpation, as well as coarse, confluent yellowish verrucous papules on the end of the residual stump (figure). Previous treatments with salicylic acid, urea, and topical corticosteroids had been unsuccessful. Skin swab analysis revealed Streptococcus agalactiae and Citrobacter koseri to be the cause of the yellowish impetiginization. We made the clinical diagnosis of papillomatosis cutis lymphostatica with verrucous hyperplasia secondary to a lack of full contact between the amputation stump and the prosthesis. The resulting negative pressure caused progressive disruption of lymphatic and venous drainage. Furthermore, stasis leads over time to verrucous hyperplasia, which is referred to as papillomatosis cutis and represents an ideal breeding ground for microbes. A polypragmatic treatment approach involving manual lymphatic drainage, fitting of a new vacuum prosthesis with a full-contact silicone lining, as well as local application of disinfectant solutions and urea-containing topical formulations produced a significant improvement in findings as well as freedom from symptoms within a matter of weeks (figure).
Figure.
Translated from the original German by Christine Rye.
Cite this as: Bender ST, Gercek E, Hofmann SC: Superinfected papillomatosis cutis lymphostatica.
Footnotes
Conflict of interest statement:
The authors state that no conflict of interest exists.