Superficial Granulomatous Pyoderma: A Case Report

A case of superficial granulomatous pyoderma is reported. A 34-year-old male presented with dark red annular necrotic and crusted erythema with soreness on both legs and buttocks for more than ten months. Physical examination showed two symmetrically distributed orbicular erythemas on the lateral sides of buttocks, 5 cm x 5 cm in size, with a central rough surface, elevated crusted border and a peripheral brownish red halo. There were tender, grayish white annular plaques on the flexural surface of both legs, the size of the right one was 20 cm x 20 cm and the left one 15cmx15cm. The plaques showed rough center, elevated reddish brown border with mild verrucous hyperplasia and sanguinopurulent exudation. Similarly, a peripheral halo was seen also. Histopathological examination revealed hyperkeratosis, parakeratosis, acanthosis, elongation of the rete ridges, spongiosis, and partial necrosis and loss of the epidermis. Fibrinoid degeneration of blood vessel walls in the superficial dermis was shown, with perivascular infiltration of lymphocytes, histiocytes, neutrophils and eosinophils. PAS stain-ing and fungal culture revealed negative results. The final diagnosis was superficial granulomatous pyoderma. The skin lesions improved markedly after treating with methylprednisolone (60 mg/d) and cyclosporin A (300 mg/d) for half a month.