Publish date: Posted on
Last updated: April 24, 2024
Keywords #
erysipelas
infection
lymphatics
superficial cutaneous cellulitis
St. Anthony’s Fire
Diagnosis #
Erysipelas is an infection of the upper dermis with lymphatic involvement. It is characterized by erythematous plaques with a clear line of demarcation. It is associated with pain and swelling, as well as fevers, rigors, nausea, and vomiting.[1] Group A beta-hemolytic Streptococcus species are the most common cause of infection, and occurs in a bimodal age distribution.[2] It should be noted that the terms erysipelas and cellulitis are interchangeable in many European countries. [1,3]
Key Concepts #
- Streptococci species are the most common cause of erysipelas.
- Erysipelas has a bimodal distribution of age.
- Treatment requires oral antibiotics.
Epidemiology #
Erysipelas is most common in infants, young children, and older adults.[2] The overall incidence of skin and soft tissue infections in the United States is approximately 2.5 cases per 100 person-years in 2002 and 4.8 cases per 100 person-years in 2015.[4,5]
Clinical Features #
- Erysipelas is often preceded by recent strep throat infection or other skin trauma, including local surgical procedures.[2]
- Erysipelas appears as bright, erythematous lesions with well-defined borders, often accompanied by edema and induration, which may give a peau d’orange appearance due to swelling around hair follicles.[1,2,3]
- Regional lymph node involvement with swelling and tenderness is common.
Differential Diagnoses #
- Cellulitis
- Contact dermatitis
- superficial thrombophlebitis
- gout
Diagnostic Workup #
No diagnostic workup is indicated for erysipelas as it is considered a clinical diagnosis.
Treatment #
Erysipelas is treated largely with penicillins as it is an infection associated with Streptococci. For mild disease, with no systemic signs, penicillin V, cephalexin, dicloxacillin, and clindamycin, are all good options. For moderate disease, with some systemic signs, penicillin G, ceftriaxone, cefazolin, and clindamycin have been indicated.[3]
Slide Viewer #
https://utahderm.med.utah.edu/image-viewer/References #
- Eriksson B, Jorup-Ronstrom C, Karkkonen K, et al. Erysipelas: clinical and bacteriologic spectrum and serological aspects. Clin Infect Dis. 1996 Jul 5; 23:1091-1098.
- Stevens DL, Bryant AE. Impetigo, erysipelas, and cellultis. In: Ferretti JJ, Stevens DL, Fischetti VA, ed. Streptococcus pyogenes: basic biology to clinical manifestations. 2016 Feb 10. University of Oklahoma Health Sciences Center. PMID: 26866211.
- Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines forthe diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014 Jul 15; 59(2):310-52.
- Ellis Simonsen SM, van Orman ER, Hatch BE, et al. Cellulitis incidence in a defined population. Epidemiol Infect. 2006 Apr; 134(2):293-299.
- Miller LG, Eisenberg DF, Liu H, et al. Incidence of skin and soft tissue infections in ambulatory and inpatient settings, 2005-2010.BMC Infect Dis. 2015 Aug 21; 15:362.
