Скачать или смотреть Erysipelas causes symptoms differential diagnosis complications treatment

ERYSIPELAS

Erysipelas is (Greek-red skin, Ignis sacer, holy fire, St Anthony fire).
An acute spreading inflammation of the upper (outer) dermis and
superficial lymphatics.
it has got typical skin rash presenting on
legs, toes, face and fingers due to acute infection by beta haemolytic
Streptococcus pyogenes, presenting as raised well demarcated skin
rash (rash is due to exotoxin).
It is more superficial than cellulitis. In
olden days, it was more common in face, now it is common in legs.
Infection occurs through a minor trauma. It affects all races; more common in females.
There will be always cutaneous lymphangitis
with development of rose pink rash with cutaneous lymphatic oedema.
Vesicles which form eventually will rupture to cause serous discharge.

Sites :

Orbit, face & ear lobule—most common.
Hands and scrotum.
Umbilicus in infants.
Decubitus ulcer of lower limb (legs and feet are now becoming more common site).

Clinical Features :

Toxaemia is always a feature.
Rash is fast spreading and blanches on pressure.
Rash is raised with sharp margin.
Redness becomes brown and later yellow with vesicles.
Discharge is serous (In cellulitis discharge is purulent).
In the face and orbit it causes severe oedema.

Milian’s ear sign is a clinical sign used to differentiate erysipelas from
cellulitis wherein ear lobule is spared. Skin of ear lobule is adherent to the subcutaneous tissue and so cellulitis cannot occur. Erysipelas being a cutaneous condition can spread into the ear lobule.

Tender, regional lymph nodes are usually palpable.

Differential diagnoses :
herpes zoster,
angioneurotic oedema,
contact dermatitis.

Complications :

Septicaemia, localized cutaneous and subcutaneous gangrene are dangerous problems.
Abscess, pneumonia, meningitis may develop.
Lymphoedema of face or eyelid or limbs (when involved) can occur due to lymphatic fibrosis.
Glomerulonephritis (not rheumatic fever), septic arthritis, necrotising fasciitis, can occur occasionally.

Recurrence rate is 20%. It causes disfiguring sequelae.

Treatment :

Penicillins, clindamycin, erythromycin, roxithromycin.
Recurrent erysipelas may require injection benzathine penicillin (long-term penicillin) monthly for 2 years.