DISCUSSION
BLP is an exaggerated chronic inflammatory reaction due to a bacterial
infection [1]. It presents as vegetating skin lesions similar to
blastomycosis or warty tuberculosis [2]. BLP is usually diagnosed in
immunocompromised patients [2]. In these cases, BLP is related to
several factors: HIV infection, alcoholism, neoplasia, malnutrition, and
immunosuppressant drugs [2]. Cases of BLP in immunocompetent
patients are rare. Local factors may be involved including injury,
foreign bodies, tattoos, radiotherapy, and trauma [11Cecchi R,
Bartoli L, Brunetti L, and Pavesi M. Blastomycosis-like pyoderma in
association with recurrent vesicular hand eczema: good response to
acitretin. Dermatol Online J . 2011 Mar; 17(3):9.Figure legend:Figure 1: Vegetating plaque of the right wrist with elevated
borders, multiple pustules and central ulceration.Figure 2: Substantial improvement after 6-day antibiotic
treatmentFigure 3: A resolution was noted after 6 months leaving a
dyspigmented scar].
Numerous micro-organisms are associated with BLP includingStaphylococcus, Streptococcus pyogenes, Pseudomonas aeruginosa,
Escherichia coli, and Candida albicans . However, Staphylococcus
aureus is the most common causative micro-organism. The mechanism by
which these microorganisms induce PLP remains unknown. Many believe that
the microbiological agent is not directly responsible for the disease
but by creating an immune dysfunction [3].
Su et al introduced [2] diagnostic criteria for BLP: (i) large
verrucous plaques with multiple pustules and elevated border, (ii)
histological evidence of pseudoepitheliomatous hyperplasia with
abscesses, (iii) identifications of bacteria by tissue culture,
(iv)negative culture for fungi and mycobacteria, (v) negative fungal
serology tests and (vi) normal bromide and iodide blood levels. Our
patient met four of these criteria.
The most effective treatment strategy includes targeted oral antibiotic
therapy. Other treatment options could be considered for selected
patients and include curettage, topical antibiotics, oral acitretin,
intralesional or systemic corticosteroids, and carbon dioxide laser
debridement [3].
Author contribution statement: Noureddine Litaiem wrote
the first draft of the manuscript. Soumaya Gara, Olfa Charfi and Soumaya
Rammeh managed the literature searches and analyses. Mariem Jones and
Faten Zeglaoui revised the manuscript. All the authors contributed to
and have approved the final manuscript.