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Skin-nontumor / Clinical Dermatology

Infectious disorders

Erysipelas

Reviewer: Ha Kirsten Do, M.D., IUPUI (see Reviewers page)
Revised: 24 August 2011, last major update September 2010
Copyright: (c) 2002-2011, PathologyOutlines.com, Inc.

Definition
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● Erysipelas is a superficial form of cellulitis and is almost always caused by Streptococcus pyogenes (Wikipedia)

Epidemiology
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● 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. Anthony’s 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

Treatment
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● 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 features
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● 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 d’orange 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

Clinical images
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Various images

Micro description
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● Marked dermal edema, vascular dilatation and streptococcal invasion of lymphatics and tissues
● The dermal inflammatory infiltrate consist of neutrophils and mononuclear cells

Virtual slides
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Erysipelas

Differential diagnosis
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● Erythema annulare centrifugum
● Stasis dermatitis

Additional references
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● Infection 1993;21:390

End of Skin-nontumor / Clinical Dermatology > Infectious disorders > Erysipelas

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