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For further information, see CMDT Part 6-30: Erysipelas
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Essentials of Diagnosis
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Edematous, circumscribed, hot, erythematous area, with raised advancing border
Central face or lower extremity frequently involved
Pain and systemic toxicity may be striking
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General Considerations
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A superficial form of cellulitis (see Cellulitis) that occurs classically on the cheek, caused by beta-hemolytic streptococci
Unlike erysipelas, erysipeloid is a benign bacillary infection producing cellulitis of the skin of the fingers or the backs of the hands in fishermen and meat handlers
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Pain, malaise, chills, and moderate fever
Central face frequently involved
A bright red patch appears first, very often near a fissure at the angle of the nose
This spreads to form a tense, sharply demarcated, glistening, smooth, hot plaque
The sharp margin characteristically advances noticeably in days or even hours
The lesion has 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
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Differential Diagnosis
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Intravenous antibiotics effective against group A beta-hemolytic streptococci and staphylococci should be considered, but outpatient treatment with oral antibiotics have 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 daily orally
Clindamycin (250 mg twice daily orally for 7–14 days) is an alternative for penicillin-allergic patients
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With appropriate treatment, erysipelas improves rapidly
Recurrence of erysipelas is uncommon
The rare infective endocarditis due to E rhusiopathiae may have mortality rates as high as 30–40% despite surgery, even in immunocompetent individuals
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Severe local symptoms and signs
Signs of sepsis
Elevated white blood cell count of 10,000/mcL (10 × 109/L) or more with marked left shift
Failure to respond to oral antibiotics
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Ren
Z
et al. Burden, risk factors, and infectious complications of cellulitis ...