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Erysipelas Share This

Erysipelas is a type of superficial cellulitis (seeBacterial Skin Infections: Cellulitis) with dermal lymphatic

involvement.

Erysipelas should not be confused with erysipeloid, a skin infection caused by Erysipelothrix(seeGram-

Positive Bacilli: Erysipelothricosis). Erysipelas is characterized clinically by shiny, raised, indurated, and

tender plaque-like lesions with distinct margins. There is also a bullous form of erysipelas. Erysipelas is

most often caused by group A (or rarely group C or G) -hemolytic streptococci and occurs most

frequently on the legs and face. However, other causes have been reported, including Staphylococcus

aureus (including methicillin-resistant S. aureus [MRSA]),Klebsiella pneumoniae,Haemophilus

influenzae,Escherichia coli,S. warneri,Streptococcus pneumoniae,S. pyogenes, and Moraxella sp.

Erysipelas of the face must be differentiated from herpes zoster, angioedema, and contact dermatitis. It is

commonly accompanied by high fever, chills, and malaise; MRSA is more common in facial erysipelas

than in lower-extremity erysipelas. Erysipelas may be recurrent and may result in chronic lymphedema.

Erysipelas

DiagnosisDiagnosis is by characteristic appearance; blood culture is done in toxic-appearing patients. Diffuse

inflammatory carcinoma of the breast may also be mistaken for erysipelas.

TreatmentUsually penicillin for lower-extremity erysipelas

Initially vancomycin

for facial erysipelas or if MRSA is suspected

Treatment of choice for lower-extremity erysipelas is penicillin V 500 mg po qid for 2 wk. In severe

cases, penicillin G

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1.2 million units IV q 6 h is indicated, which can be replaced by oral therapy after 36 to 48 h. An

alternative parenteral therapy is ceftriaxone

1 g IV q 24 h or cefazolin

1 to 2 g IV q 8 h. Dicloxacillin

500 mg po qid for 10 days can be used for infections with staphylococci.Erythromycin

500 mg po qid for 10 days may be used in penicillin-allergic patients; however, there is growing macrolide

resistance in streptococci. In infections resistant to these antibiotics, cloxacillin

or nafcillin

can be used. In Europe, pristinamycin and roxithromycin have been shown to be good choices for

erysipelas. If facial erysipelas is present or if MRSA is suspected, empiric therapy should be initiated

with vancomycin

1 g IV q 12 h (which is active against MRSA). Cold packs and analgesics may relieve local discomfort.

Fungal foot infections may be an entry site for infection and may require antifungal treatment to prevent

recurrence.