Pyoderma Vegetans Differential Diagnoses

Sections

DDx

Diagnostic Considerations

Pyoderma vegetans may resemble and needs to be distinguished from cicatricial pemphigoid vegetans^[25]and from localized pemphigus vegetans, which may be seen lacking mucosal lesions.^[26]The large verrucous plaques of pyoderma vegetans may also suggest verrucous carcinoma.^[27]

Pyoderma vegetans mimics deep fungal infections at clinical examination. As a result of this clinical resemblance, pyoderma vegetans has been labeled both mycosislike pyoderma and blastomycosislike pyoderma. North American blastomycosis and pemphigus vegetans, a rare variant of the autoimmune disorder pemphigus vulgaris, also clinically resemble pyoderma vegetans. Rarely, other deep fungal infections, including phycomycosis and coccidioidomycosis, mimic the presentation of pyoderma vegetans.

Botryomycosis, a rare bacterial infection, may present similarly to a fungal infection and may appear similar to pyoderma vegetans. Cutaneous botryomycosis is differentiated by the presence of basophilic granules that resemble the sulfur granules of actinomyces at histologic examination.^[28]Depressed immunity is also common to cutaneous botryomycosis, as seen in acquired immunodeficiency syndrome (AIDS).^{[29, 30]}In 1995, Marschalko et al suggested that cutaneous botryomycosis is a subtype of pyoderma vegetans, and they proposed that pyoderma vegetans and cutaneous botryomycosis should be classified together.^[31]

Bromoderma, mycobacterial infections, and giant keratoacanthomas are also included in the differential diagnosis.

On the penis, it must be distinguished from penile cancer.^[24]

Pyodermatitis-pyostomatitis vegetans, a rare mucocutaneous inflammatory disorder evident as vesicular, pustular, exudative, and vegetating plaques and frequently associated with ulcerative colitis, may require distinction.^{[32, 33]}The inflammatory bowel disease may be asymptomatic.^[34] Pyodermatitis pyostomatitis vegetans may be viewed as an oral variant of pyoderma vegetans.

It should be distinguished also from pyoderma gangrenosum.^[35]

Necrobiosis lipoidica with seeming progression to pyoderma vegetans was described, perhaps a coincidental association.^[36]

Differential Diagnoses

Workup

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Media Gallery

A 24-year-old woman with rapidly evolving pyoderma vegetans.
Pyoderma vegetans.

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Author

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Professor of Pediatrics, Professor of Medicine, Rutgers New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, New York Academy of Medicine, Royal College of Physicians of Edinburgh, Sigma Xi

Disclosure: Nothing to disclose.

Coauthor(s)

Justin Brown, MD Dermatologist, The Dermatology Group

Justin Brown, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society for MOHS Surgery, Sigma Xi

Disclosure: Received honoraria from Medicis for review panel membership; Received honoraria from Triax for review panel membership.

Specialty Editor Board

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society for MOHS Surgery, Association of Military Dermatologists, Phi Beta Kappa

Disclosure: Nothing to disclose.

Van Perry, MD Assistant Professor, Department of Medicine, Division of Dermatology, University of Texas School of Medicine at San Antonio

Van Perry, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Julie C Harper, MD Assistant Program Director, Assistant Professor, Department of Dermatology, University of Alabama at Birmingham

Julie C Harper, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Received honoraria from Stiefel for speaking and teaching; Received honoraria from Allergan for speaking and teaching; Received honoraria from Intendis for speaking and teaching; Received honoraria from Coria for speaking and teaching; Received honoraria from Sanofi-Aventis for speaking and teaching.

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