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Clinical:Erysipelas

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Erysipelas and the related condition cellulitis are skin infectious caused mostly by Staphylococcus aureus or group A or group B streptococci. Erysipelas affects the dermis, most often on the legs, but may also affect the face.[1]

Diagnosis

Typical features are erythema, pain, swelling, warmth, and at least a low-grade fever. Cutaneous signs of infection are orange-peel (peau d'orange) skin, vesicles, and bullae. Red streaks radiating from an infected area suggest progression of the infection into the lymphatic system. Crepitus, most often found with anaerobic organisms, is associated with increased morbidity and mortality.

The diagnosis is usually clinical. Complete blood cell counts often show leukocytosis with more than 13,000 white blood cells/µL, although in elderly or diabetic patients numeric parameters should not dictate treatment. Blood cultures are not indicated unless a patient has significant systemic symptoms, or if there is concern about bacteremia.

Treatment

For streptococcal erysipelas, treatment consists of a penicillin or cephalosporin. Azithromicin is an alternative for patients resistant to penicillin. Someone in fragile health who has erisyplas may need to be admitted to the hospital.

References

  1. Scheinfeld NS. Cellulitis and Erysipelas. Consultant 47:2 (2007)

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