Erysipelas in Adult
Clinically, it presents as a strikingly red, well-demarcated plaque that is very tender. Burning paresthesias may be present. Commonly involved areas are the face, extremities, and penis. Erysipelas 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, immunocompromised states, 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). Lymphedema and elephantiasis may also develop in the lower extremities from recurring bouts of erysipelas.
A46 – Erysipelas
44653001 – Erysipelas
Differential Diagnosis & Pitfalls
- Unilateral facial erysipelas can be confused with zoster.
- Erysipelas of the leg can be confused with stasis dermatitis.
- Fixed drug reaction
- Acute contact dermatitis is usually pruritic.
- Lyme disease
- Orbital cellulitis
- Erythema nodosum
- Deep venous thrombosis
- Acute febrile neutrophilic dermatosis (Sweet syndrome)
- Polyarteritis nodosa
- Inflammatory carcinoma of the breast
- Eosinophilic cellulitis (Wells syndrome)
- Necrotizing fasciitis
- Familial Mediterranean fever
- Cryptococcal cellulitis
- Chemical cellulitis
- Juvenile gangrenous vasculitis of the scrotum