ESSENTIALS OF DIAGNOSIS
Edematous, circumscribed, hot, erythematous area, with raised advancing border.
Central face or lower extremity frequently involved.
Pain and systemic toxicity may be striking.
Erysipelas is a superficial form of cellulitis that is caused by beta-hemolytic streptococci.
The symptoms are pain, malaise, chills, and moderate fever. A bright red spot appears and then spreads to form a tense, sharply demarcated, glistening, smooth, hot plaque. The sharp margin characteristically makes noticeable advances in days or even hours. The lesion is edematous with a raised edge and may pit slightly with the finger. Vesicles or bullae occasionally develop on the surface. The lesion does not usually become pustular or gangrenous and heals without scar formation. Breaks in the skin often provide a portal of entry for the organism. On the face, erysipelas begins near a fissure at the angle of the nose. On the lower extremity, tinea pedis with interdigital fissuring is a common portal of entry.
Leukocytosis is almost invariably present; blood cultures may be positive.
Erysipeloid is a benign bacillary infection by Erysipelothrix rhusiopathiae that produces cellulitis of the skin of the fingers or the backs of the hands in fishermen and meat handlers.
Unless erysipelas is promptly treated, death may result from bacterial dissemination, particularly in older adults.
Intravenous antibiotics effective against group A beta-hemolytic streptococci and staphylococci should be considered, but outpatient treatment with oral antibiotics has demonstrated equal efficacy. Oral regimens include a 7-day course with penicillin VK (250 mg), dicloxacillin (250 mg), or a first-generation cephalosporin (250 mg) four times a day. Clindamycin (250 mg twice daily orally for 7–14 days) is an option for penicillin-allergic patients.
With appropriate treatment, rapid improvement is expected. The presence of lymphedema carries the greatest risk of recurrence.