Erysipelas

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
  • Hand cellulitis
  • Facial cellulitis
  • Orbital cellulitis
• Erysipelas
• Lymphangitis
• Folliculitis
• Hidradenitis suppurativa
• Skin abscess
  • Anorectal abscess
  • Bartholin gland abscess
  • Pilonidal abscess
  • Scrotal abscess
• Necrotizing soft tissue infections
  • Necrotizing fasciitis
  • Necrotizing myositis
  • Necrotizing cellulitis
  • Fournier's gangrene
• 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) 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