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Erysipelas Clinical Presentation

  • Author: Loretta Davis, MD; Chief Editor: William D James, MD  more...
 
Updated: Jun 29, 2016
 

History

Patients often cannot recall an inciting event, but a history of recent trauma or pharyngitis may be elicited. Prodromal symptoms, such as malaise, chills, and high fever, often begin before the onset of the skin lesions and, if present, usually occur within 48 hours of cutaneous involvement. Pruritus, burning, tenderness, and swelling are typical complaints.

Other symptoms may include the following:

  • Muscle and joint pain
  • Nausea
  • Headache and other systemic manifestations of an infectious process

Associated comorbidities in erysipelas include diabetes mellitus, as well as hypertension, chronic venous insufficiency, and other cardiovascular diseases.[10]

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Physical Examination

Erysipelas involves the lower extremities in 80% of patients; the face is most often affected in the remainder of the cases.[11]

The patient may appear healthy or toxic depending on the extent of infection. Erysipelas begins as a small erythematous patch that progresses to a fiery-red, indurated, tense, and shiny plaque, as shown in the images below.

Well-demarcated, erythematous plaque of erysipelas Well-demarcated, erythematous plaque of erysipelas. Courtesy of the US Centers for Disease Control and Prevention.
Facial erysipelas exhibiting classic fiery-red pla Facial erysipelas exhibiting classic fiery-red plaque with raised, well-demarcated borders.

The lesion classically exhibits a sharply raised border with abrupt demarcation from healthy skin and with advancing margins, often referred to as the step sign.[14] This is in opposition to the slightly deeper involvement seen in cellulitis, in which lesions present with limited edema and less well-defined borders. Local signs of inflammation, such as warmth, edema, and tenderness, are characteristic of this infection but may be lacking in the setting of immunosuppression. Lymphatic involvement often is manifested by overlying skin streaking and regional lymphadenopathy. Erythema is irregular, with extensions that may follow lymphatic channels (lymphangitis).

More severe infections may exhibit numerous vesicles and bullae, along with petechiae and even frank necrosis. With treatment, the lesion often desquamates and can resolve with pigmentary changes that may or may not resolve over time.

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Contributor Information and Disclosures
Author

Loretta Davis, MD Professor, Department of Internal Medicine, Division of Dermatology, Medical College of Georgia

Loretta Davis, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

John A Cole, MD Dermatologist, Private Practice, Valdosta, GA

John A Cole, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Acknowledgements

Keith Benbenisty, MD Consulting Staff, Associates in Dermatology, MDs, PA

Disclosure: Nothing to disclose.

Francis Counselman, MD Program Director, Chair, Professor, Department of Emergency Medicine, Eastern Virginia Medical School

Francis Counselman, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Association of Academic Chairs of Emergency Medicine (AACEM), Norfolk Academy of Medicine, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Eddy S Lang, MDCM, CCFP(EM), CSPQ Associate Professor, Senior Researcher, Division of Emergency Medicine, Department of Family Medicine, University of Calgary; Assistant Professor, Department of Family Medicine, McGill University

Eddy S Lang, MDCM, CCFP(EM), CSPQ is a member of the following medical societies: American College of Emergency Physicians, Canadian Association of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Christen M Mowad, MD Associate Professor, Department of Dermatology, Geisinger Medical Center

Christen M Mowad, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Dermatological Association, Noah Worcester Dermatological Society, Pennsylvania Academy of Dermatology, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Robert A Schwartz, MD, MPH Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, New York Academy of Medicine, and Sigma Xi

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Reference Salary Employment

Michael J Wells, MD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

References
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  13. Coste N, Perceau G, Leone J, et al. Osteoarticular complications of erysipelas. J Am Acad Dermatol. 2004 Feb. 50(2):203-9. [Medline].

  14. Bien P, De Anda C, Prokocimer P. Comparison of Digital Planimetry and Ruler Technique To Measure ABSSSI Lesion Sizes in the ESTABLISH-1 Study. Surg Infect (Larchmt). 2014 Apr. 15(2):105-10. [Medline].

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  18. Vos MD, Bos RR, Vissink A. [A sudden redness and swelling of the face]. Ned Tijdschr Tandheelkd. 2009 Jul. 116(7):383-6. [Medline].

  19. Phares CR, Lynfield R, Farley MM, Mohle-Boetani J, Harrison LH, Petit S, et al. Epidemiology of invasive group B streptococcal disease in the United States, 1999-2005. JAMA. 2008 May 7. 299 (17):2056-65. [Medline].

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Well-demarcated, erythematous plaque of erysipelas. Courtesy of the US Centers for Disease Control and Prevention.
Facial erysipelas exhibiting classic fiery-red plaque with raised, well-demarcated borders.
 
 
 
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