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)

Diagnosis

• Often accompanied by fever, chills, malaise, HA, vomiting
• Rash
  • Local redness, heat, swelling
  • Sharp raised and indurated border

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)

Treatment

• Simple erysipelas
  • Penicillin G (300K U/d IM for <30 kg, 600K to 1 million U/d IM for >30 kg)
• Bullous erysipelas
  • Clindamycin OR Trimethoprim/Sulfamethoxazole

Source

• Tintinalli