Erysipelas

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Erysipelas is an acute superficial dermal bacterial infection, which can extend into superficial cutaneous lymphatics.

Cause

  • Streptococci, Staphylococcus aureus

Signs and symptoms

  • Growing redness and swelling of affected area
  • Fever
  • Painful, enlarged regional lymph nodes

Differential diagnosis

  • Lymphoedema
  • Acute osteomyelitis
  • Deep vein thrombosis (DVT)
  • Blunt trauma/fracture

Complications

  • Gangrene
  • Abscess
  • Scarring
  • Chronic oedema
  • Bacterial sepsis

Investigations

  • Blood culture and susceptibility tests
  • Blood glucose (to screen for diabetes)

Treatment objectives

  • Relieve pain
  • Treat predisposing factors
  • Limit the spread of the infection
  • Prevent complications

Non-pharmacological/pharmacological Treatment

-        Hydration (oral intake if possible)

-        Cold compresses

-        Elevation and resting of the affected limb to reduce pain and local swelling

-        Apply saline wet dressings to ulcerated and necrotic lesions every 12 hours

-        Debridement of the necrotic lesions

First line Treatment

Penicillin V  oral

Adult:

250mg oral every 6 hours for 5-7 days

Child:

125-250mg every 6 hours for 5-7 days)

Note:

To be taken on an empty stomach

OR       

Erythromycin oral

Adult: 500mg four times a day for 5-7 days.

Child:

Up to 2 years: 125mg

2 – 8 years: 250mg

 

For pain:

Paracetamol oral

Adult:

1 g 3 – 4 times a day as required

Child:

<3 years: 125 mg every 6 hours

> 3 years: 250mg every 6 hours)

Prevention

  • Personal hygiene with the use of antiseptic soap

Referral

  • Refer all unresolving cases to a specialist