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Erysipelas

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Topic updated on 09/03/17 10:03pm

Snapshot
  • A 70-year-old man presents with a pain on the side of his left foot. He has had long-standing tinea pedis of his left foot that did not respond to previous treatments. About a week ago, he noticed redness of his left foot. On physical exam, there is a 5 cm bright pink, warm, and tender well-demarcated plaque. He is given oral antibiotics.
Introduction
  • Clinical definition
    • bacterial infection involving the upper dermis and cutaneous lymphatics
      • often from S. pyogenes
    • from superficial involvement of skin to deep
      • impetigo (very superficial skin infection)
      • erysipelas (upper dermis and cutaneous lymphatics)
      • cellulitis (deeper dermis and subcutaneous tissues)
  • Epidemiology
    • demographics
      • common in infants, children, and older adults
    • risk factors
      • existing skin injury
      • lymphedema
      • venous insufficiency
      • diabetes
      • hypertension
      • prior streptococcal throat infection
      • tinea pedis
  • Etiology
    • S. pyogenes
      • most common
    • S. aureus
  • Pathogenesis
    • pre-existing injury in skin can act as entry portal for bacteria
  • Prognosis
    • recurs in 10-40% of cases
Presentation
  • Symptoms
    • painful and tense skin
  • Physical exam
    • well-defined bright pink and erythematous plaque
      • raised above level of surrounding normal tissue
      • clear line between involved and uninvolved tissue
      • warm
Studies
  • Labs
    • none needed
  • Diagnosed clinically
Differential
  • Cellulitis
    • deeper involvement of skin and soft tissues
    • there is often an overlap and may not be distinguished clinically from cellulitis
Treatment
  • Conservative
    • elevate affected area
      • indications
        • for all patients
  • Medical
    • penicillins
      • indications
        • for mild infection
    • cephalosporins
      • indications
        • if there is contraindication to penicillin
Complications
  • Sepsis


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