Because ecthyma extends into the dermis, it is often referred to as a deeper form of impetigo. Ecthyma begins in a fashion that is similar to superficial impetigo. Spread of skin streptococci is augmented by crowding and poor hygiene.
Lesions are painful and can have associated lymphadenopathy.
Secondary lymphangitis and cellulitis can occur. Ecthyma does heal with scarring. Ecthyma usually arises on the lower extremities of children, people with diabetes, and neglected elderly patients. During wartime in tropical climates, ecthymatous ulcers commonly were found on the ankle and dorsum of the foot. Crust is gray-yellow and is thicker and harder than the crust of impetigo.