Dermatology - Erysipelas

​Dermatology - Erysipelas
Erysipelas is a form of cellulitis that affects the lymphatic system of the skin. It is typically caused by betahemolytic streptococci bacteria. The infection is characterized by its immediate impact on the skin and subcutaneous tissues. The point of entry is typically visible, and the infection quickly spreads along the superficial lymphatic veins of the skin. Host defense deficiencies, diabetes mellitus, drug and alcohol misuse, cancer and cancer treatment, chronic lymphedema, and past bouts of cellulitis/erysipelas are also risk factors.

Fever, chills can develop swiftly, before cellulitis is obvious clinically. Elevated body temperature of 38.5°C and accompanying shivering are commonly linked to group A streptococcal infection. Lymph nodes may exhibit regional enlargement and tenderness.
Abnormalities
A crimson, scorching, swollen, lustrous patch that begins at the point of entry expands with movement towards the center and has clearly defined edges that are uneven and somewhat raised. Vesicles, bullae, erosions, abscesses, bleeding, and necrosis can develop inside plaque. The lesions exhibit tenderness and cause pain.
The diagnosis is primarily made through clinical assessment of the lesion's appearance and the patient's medical history. Confirmation through culture may be necessary in certain cases. To determine if necrotizing fasciitis is present, it is recommended to do a deep biopsy and frozen-section histology. The differential diagnosis include several conditions such as early contact dermatitis, urticaria, insect bite, fixed medication eruption, erythema nodosum, acute gout, and erythema migrans. If necrosis is observed, it is advisable to evaluate potential causes such as vascular disease, calciphylaxis, warfarin necrosis, traumatic injury, cryoglobulinemia, fixed drug eruption, pyoderma gangrenosum, and brown recluse spider bite.

To address erysipelas, administer potent antibiotics based on the specific type and susceptibility of the microorganism, which can be determined through culture testing.