erysipelas
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Introduction
Cellulitis caused by group A Streptococcus.
Etiology
Pathology
- deeper type of cellulitis
- affects dermis & subcutaneous tissue[3]
- involves the lymphatics
Clinical manifestations
- sudden onset of fever/chills, malaise
- painful, sharply demarcated erythema of the skin (erythematous plaque) with elevated borders
- local edema, induration, non-pitting
- vesicles or bullae
- skin abscesses, such as furuncles or carbuncles, suggests S aureus.
- unilateral distribution[3]
- orange peel appearance[3]
- site of predilection:
- face
- lower legs more common than face (70-80%)[8]
- areas of pre-existing lymphedema
- umbilical stump
- violet-red, well-demarcated plaque with edema on the face[4]
Laboratory
- complete blood count (CBC): leukocytosis
- gram stain of vesicular fluid
- culture of vesicular fluid
- culturing aspirate from subcutaneous tissue not helpful
- blood culture not routinely indicated[4]
Complications
- lymphatic scarring & chronic lymphedema may occur
- not life-threatening[8]
Differential diagnosis
- cellulitis
- impetigo
- malar rash of systemic lupus erythematosus
- skin abscesses, such as furuncles or carbuncles, suggests S aureus
Management
- inpatient antibiotic treatment
- cefazolin (Ancef) 1-2 g IV every 8 hours
- ceftriaxone
- penicillin G or V
- outpatient antibiotic treatment
- cephalexin (Keflex) 500 mg QID
- penicillin VK 250-500 mg BID
- erythromycin 500 mg QID (for PCN allergy)
- clindamycin
More general terms
Additional terms
References
- ↑ DeGowin & DeGowin's Diagnostic Examination, 6th edition, RL DeGowin (ed), McGraw Hill, NY 1994, pg 882
- ↑ Color Atlas & Synopsis of Clinical Dermatology, Common & Serious Diseases, 3rd ed, Fitzpatrick et al, McGraw Hill, NY, 1997, pg 634-43
- ↑ 3.0 3.1 3.2 3.3 Geriatrics at your Fingertips, 13th edition, 2011 Reuben DB et al (eds) American Geriatric Society
- ↑ 4.0 4.1 4.2 Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18, 19. American College of Physicians, Philadelphia 2012, 2015, 2018, 2021.
- ↑ 5.0 5.1 Davis L, James WD (images) Medscape: Erysipelas http://emedicine.medscape.com/article/1052445-overview
- ↑ 6.0 6.1 DermNet NZ. Erysipelas (images) http://www.dermnetnz.org/bacterial/erysipelas.html
- ↑ 7.0 7.1 NEJM Knowledge+ Question of the Week. Sept 3, 2019 https://knowledgeplus.nejm.org/question-of-week/536/
Bisno AL, Stevens DL. Streptococcal infections of skin and soft tissues. N Engl J Med 1996 Jan 25; 334:240. PMID: https://www.ncbi.nlm.nih.gov/pubmed/8532002 https://www.nejm.org/doi/full/10.1056/NEJM199601253340407
Stevens DL et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis 2014 Jun 21; 59:e10. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24947530 - ↑ 8.0 8.1 8.2 8.3 Elkston CA, Elkston DM Bacterial Skin Infections: More Than Skin Deep. Medscape. July 19, 2021 https://reference.medscape.com/slideshow/infect-skin-6003449