Erysipelas St Anthonys Fire

Erysipelas is a superficial bacterial skin infection that extends into the cutaneous lymphatics. Usually, this infection is caused by Streptococcus pyogenes and occurs on the face or lower leg. Bacterial inoculation into an area of damaged skin is the initial event in developing erysipelas, although patients may not recall the precipitating event. The source of the bacteria is often from the host's nasopharynx. A history of recent streptococcal pharyngitis is reported in up to one third of patients.

The most common complaints during the acute infection are pain, fever, chills, and swelling of the skin. Infants, young children, and older adult patients are the groups most often affected, with a peak incidence at age 60 to 80. Erysipelas may become a red, indurated, tense, and shiny plaque with sharply demarcated margins. Local inflammatory signs, such as warmth, edema, and tenderness, are universal. Lymphatic involvement is manifested by a peau d'orange look to the skin, with sharp borders and regional lymphadenopathy. More severe infections may include numerous vesicles or bullae, petechiae, and even skin necrosis. Streptococci cause erysipelas in as many as 80% of cases, with two thirds of those caused by group A and 25% by group G streptococci. S. aureus has been implicated in cases of recurrent erysipelas secondary to lymphedema. Atypical forms have been caused by Streptococcus pneumoniae, Klebsiella pneumoniae, Yersinia enterocolitica, and Moraxella spp. and should be considered in cases refractory to standard antibiotic therapy.

In cases involving the extremities, elevation and rest of the affected limb are recommended to reduce local swelling and inflammation. Oral or intramuscular (IM) penicillin for 10 to 14 days is sufficient for many cases of erysipelas. A macrolide such as erythromycin or azithromycin may be used if the patient is allergic to penicillin. Hospitaliza-tion for close monitoring and intravenous (IV) antibiotics are recommended for severe cases and for infants, older adults, and immunocompromised patients. Facial erysipelas should be treated empirically with a penicillinase-resis-tant antibiotic such as dicloxacillin to cover for possible S. aureus. Predisposing skin lesions, such as tinea pedis and stasis ulcers, should be treated aggressively to prevent superinfection.

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