Erysipelas: Difference between revisions
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*Specific form of cellulitis involving the epidermis, upper levels of the dermis, and the lymphatics | *Specific form of cellulitis involving the epidermis, upper levels of the dermis, and the lymphatics | ||
*Most often caused by strep | *Most often caused by strep | ||
*Bullous erysipelas, a more severe form of the disease, is often caused by staph (and MRSA) | **Bullous erysipelas, a more severe form of the disease, is often caused by staph (and MRSA) | ||
== | ==Clinical Features== | ||
*Rash | *Rash | ||
**Local redness, heat, swelling | **Local redness, heat, swelling | ||
**Sharp raised and indurated border | **Sharp raised and indurated border | ||
*Can be accompanied by fever, chills, malaise, headache, nausea/vomiting | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Template:SSTI DDX}} | {{Template:SSTI DDX}} | ||
== | ==Diagnosis== | ||
*Clinical diagnosis, based on history and physical exam | |||
==Management== | |||
===[[Antibiotics]]=== | ===[[Antibiotics]]=== | ||
{{Erysipelas antibiotics}} | {{Erysipelas antibiotics}} | ||
== | ==Disposition== | ||
* | *Generally may be discharged with outpatient treatment | ||
==See Also== | |||
==References== | |||
<References/> | |||
[[Category:Derm]] | [[Category:Derm]] | ||
Revision as of 07:19, 22 August 2015
Background
- Specific form of cellulitis involving the epidermis, upper levels of the dermis, and the lymphatics
- Most often caused by strep
- Bullous erysipelas, a more severe form of the disease, is often caused by staph (and MRSA)
Clinical Features
- Rash
- Local redness, heat, swelling
- Sharp raised and indurated border
- 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)
Diagnosis
- 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[1]) 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
- ↑ 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.