—We Hurwitz and his colleagues for their comments strengthening our assumption that ecthyma gangrenosum may be a localized skin lesion not accompanied by bacteremia. However, we think that "necrotic cellulitis" described by Hurwitz and his colleagues is not synonymous with ecthyma gangrenosum but, rather, with a similar cutaneous manifestation of Pseudomonas septicemia, ie, gangrenous cellulitis. Thsi is a sharply demarcate cellulitis that rapidly enlarges to become a necrotic lesion1 and does not evolve through several typical stages, as does ecthyma gangrenosum. The description and figures of the skin lesion in patinet 1 of Hurwitz and his colleagues fit gangrenous or necrotic cellulitis and not ecthyma gangrenosum. Patient 2 in their article had bacteremia. Nevertheless, it appears that both necrotic cellulitis and ecthyma gangrenosum may develop in patients who do not have bacteremia.