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Updated: Dec 15 2021


  • 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)
    • Pathogenesis
      • pre-existing injury in skin can act as entry portal for bacteria
  • 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
  • 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
  • Prognosis
    • Recurs in 10-40% of cases
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