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Erysipelas in Child
See also in: Cellulitis DDx,Anogenital
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Erysipelas in Child

See also in: Cellulitis DDx,Anogenital
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Contributors: Lori Prakash DO, Noah Craft MD, PhD, Jeffrey D. Bernhard MD
Other Resources UpToDate PubMed

Synopsis

Erysipelas is a superficial bacterial infection of the skin most often caused by beta-hemolytic group A streptococci (Streptococcus pyogenes). It involves the lymphatics of the superficial dermis. Erysipelas usually occurs in isolation and has a predilection for the extremes of age, debilitated patients, and patients with poor lymphatic drainage. Historically, erysipelas occurred on the face, but at the present time, this infection is more commonly seen on the lower extremities of adults with venous insufficiency and stasis dermatitis. In children, the scalp, face, and hands are still the most common sites of involvement, although it may occur anywhere. Neonates present more commonly with rapidly spreading periumbilical erythema. Some view erysipelas as an extreme form of cellulitis.

Clinically, the infection presents as strikingly red, well-demarcated plaques that are very tender. Burning paresthesias may be present. Commonly involved areas are the face, extremities, and penis. Cutaneous findings are usually preceded by abrupt onset of fever, chills, nausea, and malaise. In neonates and infants, poor feeding, irritability, and lethargy may accompany erysipelas. Lymphadenopathy is almost always present.

Trauma to the skin is thought to be an important factor in the development of erysipelas; therefore, a concomitant dermatophyte infection, surgical incision, ulceration, insect bite, or inflammatory skin condition may provide a portal of entry for bacteria. The nasopharynx is often the reservoir in cases of facial erysipelas. Additional predisposing factors for erysipelas include diabetes, an immunocompromised state, and nephrotic syndrome.

Penile erysipelas responds to treatment with antibiotics but tends to recur, causing a progressive, chronic lymphedema with permanent swelling of the penis (elephantiasis). Elephantiasis may also develop in the lower extremities from recurring bouts of erysipelas.

If not treated promptly, complications in children include meningitis, septicemia, endocarditis, toxic shock, and necrotizing fasciitis.

Codes

ICD10CM:
A46 – Erysipelas

SNOMEDCT:
44653001 – Erysipelas

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Last Updated: 03/21/2019
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Erysipelas in Child
See also in: Cellulitis DDx,Anogenital
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Erysipelas : Chills, Fever, Painful skin lesions, Skin warm to touch, Blanching patch, WBC elevated
Clinical image of Erysipelas
A close-up of a deeply erythematous, edematous, and vesiculated patterned plaque on the buttock.
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