Erysipelas

Erysipelas

OVERVIEW:

Bacterial cellulitis involving the superficial skin and lymphatics usually due to group A streptococcus. Usually acute, but a chronic recurrent form also exists.

System(s) affected: Skin/Exocrine
Genetics: N/A
Incidence/Prevalence in USA: Unknown
Predominant age: Usually infants and adults over 40. Greatest in elderly (> 75 years).
Predominant sex: Male = Female

SIGNS AND SYMPTOMS:

• Prodrome of malaise, fever and chills
• Headache, vomiting are prominent
• Arthralgias
• Pruritus
• Skin discomfort
• Vesicles
• Facial redness
• Acute onset of erythema
• Begins as erythematous patch
• Sharply demarcated raised border
• Center of lesion clears as periphery spreads
• Desquamation and vesicle formation can occur
• Face is the most common area involved, especially nose and ears
• Chronic form may recur hours to years after initial episode
• Chronic form usually recurs at site of the previous infection
• Fever is usually the differentiating factor among similar skin manifestations

CAUSES:

Group A beta-hemolytic streptococcus primarily; occasionally other strep groups or staph

RISK FACTORS:

• Operative wounds
• Fissured skin (especially at the nose and ears)
• Any inflamed skin
• Traumatic wounds/abrasions
• Leg ulcers/stasis dermatitis
• Chronic diseases (diabetes, malnutrition, nephrotic syndrome)
• Immunocompromised or debilitated individual

DIAGNOSIS

DIFFERENTIAL DIAGNOSIS:

• Erysipeloid (little toxicity)
• Contact dermatitis (no fever)
• Angioneurotic edema (no fever)
• Scarlet fever (usually more widespread without edema)
• Lupus (of the face, less fever, positive antinuclear antibodies)
• Polychondritis (of the ear)
• Dermatophytid
• Tuberculoid leprosy

LABORATORY:

• Leukocytosis (usually > 15,000)
• Strep may be cultured from exudate or from non-involved sites
• Antistreptolysin (ASO), streptozyme, anti-DNase may be helpful
• Blood culture (< 5% positive)

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS:

• Edema
• Vasodilation and enlarged lymphatics
• Infiltration of polymorphonuclear leukocytes, lymphocytes and other inflammatory cells
• Endothelial cell swelling
• Gram positive cocci

SPECIAL TESTS:

N/A

IMAGING:

N/A

DIAGNOSTIC PROCEDURES:

None

TREATMENT

APPROPRIATE HEALTH CARE:

Outpatient

GENERAL MEASURES:

• Symptomatic treatment of aches and fever
• Adequate fluid intake
• Local treatment with cold compresses

SURGICAL MEASURES:

N/A

ACTIVITY:

Bedrest with activity based on severity of illness

DIET:

No special diet

PATIENT EDUCATION:

Importance of completing medication regimen prescribed

MEDICATIONS

DRUG(S) OF CHOICE:

• Penicillin V (Pen VK) for at least ten days (improvement in 24-48 hours). Children: 25-50 mg/kg/day divided q6h; Adults: 250-500 mg/dose q6h.
• Parenteral antibiotics are recommended for severe or complicated cases (1-2 million units every 4-6 hours)
• In chronic recurrent infections some authors recommend lower dose daily maintenance/prophylactic treatment after the acute infection resolves

Contraindications: Penicillin allergy
Precautions: Refer to manufacturer's profile of each drug
Significant possible interactions: Refer to manufacturer's profile of each drug

ALTERNATIVE DRUGS:

• Erythromycin. Children: 30-40 mg/kg/day divided q6h; adults: 250 mg/dose q6h.
• Cephalosporins

FOLLOW UP

PATIENT MONITORING:

Patients should be treated until all symptoms and skin manifestations have resolved

PREVENTION/AVOIDANCE:

• Maintenance antibiotics for chronic recurrent cases
• Men who shave within five days of facial erysipelas are more likely to have a recurrence
• In recurrent cases, search for other possible source of streptococcal infection (e.g., tonsils, sinuses, teeth, toenails, etc.)

POSSIBLE COMPLICATIONS:

• Bacteremia
• Scarlet fever
• Pneumonia
• Abscess
• Embolism
• Gangrene
• Meningitis
• Sepsis
• Death

EXPECTED COURSE AND PROGNOSIS:

• Adequate treatment results in full recovery
• Chronic edema/scarring can result from chronic recurrent cases
• Rarely elephantiasis may result from chronic recurrent cases
• Untreated cases sometimes will resolve spontaneously

MISCELLANEOUS

ASSOCIATED CONDITIONS:

N/A

AGE-RELATED FACTORS:

Pediatric:
• Group B strep may be a cause in neonates/infants
• Abdominal involvement more common in infants
• Face, scalp, and leg common in older children
Geriatric:
• Fever may not be as prominent
• More prone to complications
• High output cardiac failure may occur in debilitated patients with underlying cardiac disease
• Face and lower extremity most common areas
Others: N/A

PREGNANCY:

N/A

SYNONYMS:

• Saint Anthony's fire
• Ignis sacer

ICD-9-CM:

035 Erysipelas

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Medical Diagnosis » E » Erysipelas