erysipelas

Question 1

What is erysipelas

Answer 1

localised skin infection caused by Streptococcus pyogenes. In simple terms, it is a more superficial, limited version of cellulitis.

Question 2

What is treatment of erysipelas

Answer 2

Flucloxacillin erythromycin preferred if penicillin allergic.

Question 3

Difference between erysipelas and cellulitsi

Answer 3

Cellulitis refers to infection of the dermis and subcutaneous tissue. Erysipelas refers to infection of the dermis and upper subcutaneous tissue

Question 4

Clinical features of erysipelas

Answer 4

Borders are sharply defined and affected skin is raised, swollen, firm, erythematous and pruritic.

Question 5

Where does it effect

Answer 5

Lower limbs or butterfly across face

Question 6

What is the cause

Answer 6

Almost all are caused by group A beta-haemolytic streptococci - unlike cellulitis

Question 7

What is the source of infection

Answer 7

If face affected, this source of infection is usually the nasopharynx (possibly recent nasopharyngeal infection).

Question 8

What systemic features may arise

Answer 8

Both Cellulitis and Erysipelas may be accompanied by systemic symptoms (e.g. fever, fatigue, malaise)

Question 8

What are the risk factors

Answer 8

Previous erysipelas/cellulitis
Venous insufficiency
Immune deficiency (e.g. Diabetes, HIV, Alcoholism)
Breaks in skin barrier (bites, ulcers, psoriasis, eczema)
Obesity
Fissured toes or heels due to athlete’s foot or tinea pedis - cause skin breakage allowing entry of infective organisms.

Question 9

What are the investigations

Answer 9

Usually clinical
Blood tests to look for raised inflammatory markers
Cultures from sites of original entry of infection e.g. skin breaks.
Culturing fluid from bullae, frank pus or abscesses
Imaging if underlying bone thought to be involved