Erysipelas: Difference between revisions
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==Background== | ==Background== | ||
*Specific form of cellulitis involving the superficial levels of the dermis and subcutaneous tissues (including lymphatics)<ref name="Gunderson">Gunderson CG, Martinello RA. A systematic review of bacteremias in cellulitis and erysipelas. J Infect. 2012 Feb;64(2):148-55.</ref> | {{Skin anatomy background images}} | ||
*Majority of cases caused by streptococcus<ref name="Gunderson" /><ref name="GC" /> | *Specific form of [[cellulitis]] involving the superficial levels of the dermis and subcutaneous tissues (including lymphatics)<ref name="Gunderson">Gunderson CG, Martinello RA. A systematic review of bacteremias in cellulitis and erysipelas. J Infect. 2012 Feb;64(2):148-55.</ref> | ||
**However, recent data indicates ''S. aureus'' (specifically, CA-MRSA) is a rising cause. | *Majority of cases caused by [[streptococcus]]<ref name="Gunderson" /><ref name="GC" /> | ||
**However, recent data indicates ''[[S. aureus]]'' (specifically, CA-MRSA) is a rising cause. | |||
*Usually affects lower extremities (face is also common)<ref name="Linke">Linke M, Booken N. Risk factors associated with a reduced response in the treatment of erysipelas. J Dtsch Dermatol Ges. 2015 Mar;13(3):217-25.</ref> | *Usually affects lower extremities (face is also common)<ref name="Linke">Linke M, Booken N. Risk factors associated with a reduced response in the treatment of erysipelas. J Dtsch Dermatol Ges. 2015 Mar;13(3):217-25.</ref> | ||
==Clinical Features== | ==Clinical Features== | ||
*Rash | *[[Rash]] | ||
**Local erythema, warmth, swelling | **Local erythema, warmth, swelling | ||
**Well demarcated and raised border<ref name="Gunderson" /> | **Well demarcated and raised border<ref name="Gunderson" /> | ||
*Can be accompanied by fever, chills, malaise, headache, nausea/vomiting | *Can be accompanied by [[fever]], chills, malaise, [[headache]], [[nausea/vomiting]] | ||
[[File:erysipelas_well_demarcated.JPG|thumbnail]] | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{ | {{SSTI DDX}} | ||
{{Erythematous rash DDX}} | |||
== | ==Evaluation== | ||
===Work-up=== | ===Work-up=== | ||
*Unlike [[Necrotizing fasciitis]] and skin infections with purulent collections or exudates, bacteriology work-up (biopsy, blood culture, etc) generally does not yield results in erysipelas.<ref name="GC">Gabillot-Carré M, Roujeau JC. Acute bacterial skin infections and cellulitis. Curr Opin Infect Dis. 2007 Apr;20(2):118-23.</ref> | *Unlike [[Necrotizing fasciitis]] and skin infections with purulent collections or exudates, bacteriology work-up (biopsy, blood culture, etc) generally does not yield results in erysipelas.<ref name="GC">Gabillot-Carré M, Roujeau JC. Acute bacterial skin infections and cellulitis. Curr Opin Infect Dis. 2007 Apr;20(2):118-23.</ref> | ||
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<References/> | <References/> | ||
[[Category: | [[Category:Dermatology]] | ||
Latest revision as of 16:23, 11 December 2024
Background
- Specific form of cellulitis involving the superficial levels of the dermis and subcutaneous tissues (including lymphatics)[1]
- Majority of cases caused by streptococcus[1][2]
- However, recent data indicates S. aureus (specifically, CA-MRSA) is a rising cause.
- Usually affects lower extremities (face is also common)[3]
Clinical Features
- Rash
- Local erythema, warmth, swelling
- Well demarcated and raised border[1]
- Can be accompanied by fever, chills, malaise, headache, nausea/vomiting
Differential Diagnosis
Skin and Soft Tissue Infection
- Cellulitis
- Erysipelas
- Lymphangitis
- Folliculitis
- Hidradenitis suppurativa
- Skin abscess
- Necrotizing soft tissue infections
- Mycobacterium marinum
Look-A-Likes
- Sporotrichosis
- Osteomyelitis
- Deep venous thrombosis
- Pyomyositis
- Purple glove syndrome
- Tuberculosis (tuberculous inflammation of the skin)
Erythematous rash
- Positive Nikolsky’s sign
- Febrile
- Staphylococcal scalded skin syndrome (children)
- Toxic epidermal necrolysis/SJS (adults)
- Afebrile
- Febrile
- Negative Nikolsky’s sign
- Febrile
- Afebrile
Evaluation
Work-up
- Unlike Necrotizing fasciitis and skin infections with purulent collections or exudates, bacteriology work-up (biopsy, blood culture, etc) generally does not yield results in erysipelas.[2]
Evaluation
- Clinical diagnosis, based on history and physical exam
Management
Antibiotics
Coverage for S. pyogenes
- Penicillin G 300K U/d IM for <30 kg, 600K to 1 million U/d IM for >30 kg (first line therapy[3]) OR
- Clindamycin 450mg (5mg/kg) PO q8hrs x 10 days (if PCN allergic) OR
- Cephalexin 500mg (6.25mg/kg) PO q6hrs x 10 days OR
- Ceftriaxone 1g (50mg/kg) IV once daily x 10 days OR
- Levofloxacin 500mg PO/IV daily x 10 days OR
- Augmentin 500mg PO BID x 10 days (generally reserved for failure of first line therapy)
Bullous Erysipela or MRSA suspected: trimethoprim-sulfamethoxazole, clindamycin, doxycycline, or minocycline
Disposition
- Generally may be discharged with outpatient treatment
See Also
References
- ↑ 1.0 1.1 1.2 Gunderson CG, Martinello RA. A systematic review of bacteremias in cellulitis and erysipelas. J Infect. 2012 Feb;64(2):148-55.
- ↑ 2.0 2.1 Gabillot-Carré M, Roujeau JC. Acute bacterial skin infections and cellulitis. Curr Opin Infect Dis. 2007 Apr;20(2):118-23.
- ↑ 3.0 3.1 Linke M, Booken N. Risk factors associated with a reduced response in the treatment of erysipelas. J Dtsch Dermatol Ges. 2015 Mar;13(3):217-25.