Updated: 12/8/2019

Erysipelas

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Snapshot
  • An 18-year-old man presents with a painful rash on his upper arm. He reports a recent mosquito bite in the same area three weeks ago. Since then, the area has become red, painful, and hot. On physical exam, his physician notes a well-demarcated raised area that is bright pink and hot to the touch. He is sent home on penicillin.
Introduction
  • Clinical definition
    • bacterial infection involving the upper dermis and cutaneous lymphatics
      • often from S. pyogenes
    • from superficial involvement of skin to deep
      • impetigo (very superficial skin infection)
      • erysipelas (upper dermis and cutaneous lymphatics)
      • cellulitis (deeper dermis and subcutaneous tissues)
  • Epidemiology
    • demographics
      • common in infants, children, and older adults
    • risk factors
      • existing skin injury
      • lymphedema
      • venous insufficiency
      • diabetes
      • hypertension
      • prior streptococcal throat infection
      • tinea pedis
  • Etiology
    • S. pyogenes
      • most common
    • S. aureus
  • Pathogenesis
    • pre-existing injury in skin can act as entry portal for bacteria
  • Prognosis
    • recurs in 10-40% of cases
Presentation
  • Symptoms
    • painful and tense skin
  • Physical exam 
    • well-defined bright pink and erythematous plaque
      • raised above level of surrounding normal tissue
      • clear line between involved and uninvolved tissue
      • warm
Studies
  • Labs
    • none needed
  • Diagnosed clinically
Differential
  • Cellulitis
    • deeper involvement of skin and soft tissues
    • there is often an overlap and may not be distinguished clinically from cellulitis
Treatment
  • Conservative
    • elevate affected area
      • indications
        • for all patients
  • Medical
    • penicillins
      • indications
        • for mild infection
    • cephalosporins
      • indications
        • if there is contraindication to penicillin
    • flucloxacillin 
Complications
  • Sepsis

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