- Specific form of cellulitis involving the superficial levels of the dermis and subcutaneous tissues (including lymphatics)
- Majority of cases caused by streptococcus
- However, recent data indicates S. aureus (specifically, CA-MRSA) is a rising cause.
- Usually affects lower extremities (face is also common)
- Local erythema, warmth, swelling
- Well demarcated and raised border
- Can be accompanied by fever, chills, malaise, headache, nausea/vomiting
- Hidradenitis suppurativa
- Skin abscess
- Necrotizing soft tissue infections
- Mycobacterium marinum
- Positive Nikolsky’s sign
- Negative Nikolsky’s sign
- Unlike Necrotizing fasciitis and skin infections with purulent collections or exudates, bacteriology work-up (biopsy, blood culture, etc) generally does not yield results in erysipelas.
- Clinical diagnosis, based on history and physical exam
Coverage for S. pyogenes
- Penicillin G 300K U/d IM for <30 kg, 600K to 1 million U/d IM for >30 kg (first line therapy) OR
- Clindamycin 450mg (5mg/kg) PO q8hrs x 10 days (if PCN allergic) OR
- Cephalexin 500mg (6.25mg/kg) PO q6hrs x 10 days OR
- Ceftriaxone 1g (50mg/kg) IV once daily x 10 days OR
- Levofloxacin 500mg PO/IV daily x 10 days OR
- Augmentin 500mg PO BID x 10 days (generally reserved for failure of first line therapy)
- Generally may be discharged with outpatient treatment
- Gunderson CG, Martinello RA. A systematic review of bacteremias in cellulitis and erysipelas. J Infect. 2012 Feb;64(2):148-55.
- Gabillot-Carré M, Roujeau JC. Acute bacterial skin infections and cellulitis. Curr Opin Infect Dis. 2007 Apr;20(2):118-23.
- Linke M, Booken N. Risk factors associated with a reduced response in the treatment of erysipelas. J Dtsch Dermatol Ges. 2015 Mar;13(3):217-25.