ContentsSynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyReferencesInformation for PatientsView all Images (52)
Erysipelas in Adult
See also in: Cellulitis DDx,Anogenital
Print Captions OFF
Other Resources UpToDate PubMed

Erysipelas in Adult

See also in: Cellulitis DDx,Anogenital
Print Patient Handout Images (52)
Contributors: Tara Mahar MD, Art Papier 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 patients with venous insufficiency and stasis dermatitis. There are some that view erysipelas as an extreme form of cellulitis.

Clinically, it 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. May occur in tattoos. Cutaneous findings are usually preceded by abrupt onset of fever, chills, nausea, and malaise. 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 alcohol use disorder, 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.

There is no geographic distribution of erysipelas. However, because pyodermas (purulent skin diseases) are among the most frequently reported complaints in returning travelers, a high degree of clinical suspicion is warranted.

Codes

ICD10CM:
A46 – Erysipelas

SNOMEDCT:
44653001 – Erysipelas

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

Best Tests

Subscription Required

Management Pearls

Subscription Required

Therapy

Subscription Required

References

Subscription Required

Last Updated: 04/23/2019
Copyright © 2019 VisualDx®. All rights reserved.
Erysipelas in Adult
See also in: Cellulitis DDx,Anogenital
Captions OFF Print 52 Images Filter Images
View all Images (52)
(with subscription)
 Reset
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.
Copyright © 2019 VisualDx®. All rights reserved.