Table of Contents
Definition / general | Epidemiology | Clinical features | Treatment | Clinical images | Microscopic (histologic) description | Differential diagnosis | Additional referencesCite this page: Do HK. Erysipelas. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/skinnontumorerysipelas.html. Accessed September 25th, 2023.
Definition / general
- Erysipelas is a superficial form of cellulitis and is almost always caused by Streptococcus pyogenes (Wikipedia)
Epidemiology
- Can affect any age group but commonly affect infants and elderly
- Tracing back to the Middle Ages, it historically occurred on the face and was referred to as St. Anthonys Fire, after an Egyptian healer (eMedicine)
- More recently, its distribution has shifted to the lower extremities due to an aging population with risk factors such as leg venous insufficiency; 75% of cases now occur in legs (Int J Dermatol 2010;49:1012)
- Its incidence has declined throughout the 20th century, possibly due to antibiotics and improved sanitation
Clinical features
- Lesions predominantly appear on lower limbs, but when it involves the face, it gives rise to a characteristic butterfly distribution on the cheeks and bridge of the nose
- Usually abrupt onset; can be distinguished from other forms of cellulitis by a sharply demarcated, raised border
- Causes upper dermal edema with blockage of the superficial lymphatics, causing the clinical orange peel or peau dorange appearance of the affected skin and localized lymphadenopathy
- May be accompanied by constitutional symptoms of fever, chills, malaise
- Preexisting lymphedema is a known risk factor (Acta Dermatovenerol Alp Panonica Adriat 2009;18:63)
- Rare complications include:
- Infective endocarditis or septic arthritis with septicemia
- Post-streptococcal glomerulonephritis in children
- Facial erysipelas can cause cavernous sinus thrombosis
- Streptococcal toxic shock syndrome
Treatment
- IV and PO penicillin
- Erythromycin can be used in those with penicillin allergies
- Treatment requires 10 - 14 days of antibiotics; no scarring occurs
- Prognosis is excellent with appropriate antibiotic therapy; however, local recurrence has been reported in up to 20% of patients with predisposing conditions
- Recurrent erysipelas is treated with local antiseptics, general wound care and long term management of lymphedema (Neth J Med 2007;65:89)
- Currently, there are no guidelines for long term antibiotics; one regimen is 2.4 MU benzathin-penicillin G IM every 2 weeks, for up to 2 years (J Eur Acad Dermatol Venereol 2006;20:818)
Clinical images
Images hosted on other servers:
Various images
Microscopic (histologic) description
- Marked dermal edema, vascular dilatation and streptococcal invasion of lymphatics and tissues
- Dermal inflammatory infiltrate consist of neutrophils and mononuclear cells
Differential diagnosis
Additional references
