Erysipelas in Child
Clinically, the infection presents as a strikingly red, well-demarcated plaque that is very tender. Burning paresthesias may be present. Cutaneous findings are usually preceded by abrupt onset of fever, chills, nausea, and malaise. In neonates and infants, poor feeding, irritability, and lethargy may accompany erysipelas. 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 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). Elephantiasis may also develop in the lower extremities from recurring bouts of erysipelas.
If not treated promptly, complications in children include meningitis, septicemia, endocarditis, toxic shock, and necrotizing fasciitis.
A46 – Erysipelas
44653001 – Erysipelas
Differential Diagnosis & Pitfalls
- Periorbital / orbital cellulitis
- Toxic shock syndrome
- Nummular eczema
- Insect bite hypersensitivity
- Erythema migrans (see Lyme disease)
- Necrotizing fasciitis
- Acute contact dermatitis
- Drug reactions
- Deep venous thrombosis
- Neonatal omphalitis
- Juvenile gangrenous vasculitis of the scrotum
- Herpes zoster