Erysipelas is a superficial bacterial
skin infection that is characteristically
extends into cutaneous lymphatics .
It was referred to as :
Saint Anthony's Fire (= ergotism or
erysipelas or Herpes zoster )
7. * Streptococci are the primary
cause of erysipelas.
* Most facial infections are
attributed to group A
*lower extremity infections
being caused by non–group A
•Streptococcal toxins are thought to
contribute to the brisk inflammation
that is pathognomonic of this infection.
*No clear proof has emerged that other
bacteria cause typical erysipelas,
although they clearly coexist with
streptococci at sites of inoculation.
Recently, atypical forms reported to be
caused by :
* Streptococcus pneumoniae,
* Haemophilus influenzae,
they should be considered in cases refractory
to standard antibiotic therapy.
Erysipelas infections affect persons of all
•Erysipelas is common in females.
• at an earlier age it is more in males ( more
• However predisposing factors, rather than
gender, account for any male/female
differences in incidence.
All age groups are susiptable.
The peak incidence at 60-80 years
old, especially in patients :
= At high-risk .
= immuno-compromised .
= those with lymphatic drainage
problems (eg, after mastectomy, pelvic
surgery, bypass grafting).
26. Erythema Annulare Centrifugum
* Eruptions occur at any
* begins as small raised
pink-red spot that slowly
enlarges and forms a ring
shape while the central
area flattens and clears.
There may be an inner
rim of scale.
* acute bacterial infection of traumatized skin.
* caused by Erysipelothrix rhusiopathiae
(gram positive rod-shaped bacterium), which
cause animal and human infections.
* Direct contact between infected meat and
traumatized human skin results in Erysipeloid.
•more common among
farmers, butchers, cooks, homemakers.
* Lesions most commonly affect the hands.
33. Laboratory Studies
* In classic erysipelas, no
laboratory workup is required
for diagnosis or treatment.
* Cultures are best reserved for
immunocopromized patient in
whom an atypical etiologic agent
34. Imaging Studies
Imaging studies are not usually
indicated and are of low yield.
MRI and bone scintigraphy are
helpful when early osteoarticular
involvement is suspected.
In this setting, standard
radiographic findings typically are
35. Histological Findings
The histological hallmarks of erysipelas are
*marked dermal edema,
*streptococcal invasion of lymphatics & tissues.
This bacterial invasion results in a dermal
inflammatory infiltrate consisting of
neutrophils and mononuclear cells.
The epidermis is often secondarily involved.
Rarely, bacterial invasion of local blood vessels
may be seen.
37. Hospitalization for close monitoring
and IV. antibiotics is recommended
1) severe cases.
3) elderly patients.
4) patients who are immune-
38. Medical Care
* Elevation and rest of the affected
limb are recommended to reduce
local swelling, inflammation, and pain.
* Saline wet dressings should be
applied to ulcerated and necrotic
lesions and changed every 2-12 hours,
depending on the severity of the
39. * penicillin has remained first-line therapy.
administered orally or IM. for 10-20 days.
Dosing : Adult
Penicillin G procaine: 0.6-1.2 million U IM bid for 10 d
Penicillin VK: 250-500 mg PO qid for 10-14 d
Pediatric : Penicillin G procaine: <30 kg: 300,000 U/d
>30 kg: Administer as in adults
<12 years: 25-50 mg/kg/d PO divided tid/qid;
not to exceed 3 g/d
>12 years: Administer as in adults
40. Medical Care
*A first-generation cephalosporin or
macrolide, such as erythromycin or
azithromycin, may be used if the patient has
an allergy to penicillin.
250-500 mg PO qid for 10 d
30-50 mg/kg/d (15-25 mg/lb/d) PO divided
q6-8h; double dose for severe infection.
41. •Two new drugs:
• roxithromycin & pristinamycin,
have been reported to be extremely
effective in the treatment of erysipelas.
* Several studies have demonstrated greater
efficacy and fewer adverse effects with
these drugs compared with penicillin.
*Currently, FDA has not approved these
drugs in the United States, but they are in
use in Europe.
43. Patients with recurrent erysipelas
should be educated regarding :
•local antisepstic .
•general wound care.
•Predisposing lower extremity skin
lesions (eg , tineapedis , toe
web intertrigo , stasis ulcers) should
be treated aggressively to prevent
44. •Long-term prophylactic antibiotic therapy
generally is accepted, but no true guidelines are
•Treatment regimens should be tailored to the
•One reported regimen is benzathine
penicillin G at 2.4 MU IM. every 3 weeks
for up to 2 years . Two-week intervals
have also been used.