Erysipelas and Molluscum Contagiosum

by Carlo Raj, MD

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    00:02 Our topic here is erysipelas.

    00:04 It’s a special form or type of cellulitis caused by strep A.

    00:08 Demographics of erysipelas: Children or elderly with poor circulation.

    00:14 What does it look like? Bright red, erythematous plaques.

    00:18 Rapidly advancing borders and profound edema.

    00:22 And common on the face or lower extremities.

    00:25 Strep A infection, poor circulation, diabetics or children.

    00:31 Differential diagnoses for erysipelas: Classic cellulitis.

    00:35 Erysipelas is more superficial.

    00:38 Cellulitis is deeper.

    00:40 Erysipelas demonstrates a brighter erythema and advances more rapidly than traditional cellulitis.

    00:47 What’s the infection that you’re thinking about notably? Strep A.

    00:52 Stasis dermatitis.

    00:54 Here, you’re thinking about lower legs in which there is insufficient circulation.

    01:00 So maybe your patient has varicose veins, in your female.

    01:03 And so there’s faulty valves which is then not allowing for proper movement or circulation of your blood from your veins from the lower legs moving up towards your heart or right side of the heart.

    01:16 So with that stasis, commonly bilateral, develops more insidiously than erysipelas.

    01:21 Remember erysipelas, very rapid strep A.

    01:23 Extremely red and the borders are advancing rather quickly.

    01:27 Stasis not associated with systemic symptoms, strep A could be.

    01:33 If you take a look at the picture here, I’m showing you extremely erythematous type of lesion.

    01:37 It’s a strep A infection.

    01:39 And we call this a St. Vincent’s fire because of how incredibly fiery red this condition is.

    01:50 Management: Oral antibiotics, follow close-up because of how quickly this then moves and make sure that because of the way in which this spreads that there’s hospitalization for facial lesions.

    02:04 Molluscum contagiosum is a type of poxvirus.

    02:08 Molluscum contagiosum virus.

    02:12 Morphology: Think of this as being kind of like a volcano or the umbilicus.

    02:18 So you have central umbilication and what ends up happening if you find these lesions of the skin, a papule lesion that looks like a volcano or umbilicated on the skin and if you rub this, think of now your volcano erupting, but then this is the actual virus, the poxvirus, which is then spreading locally.

    02:38 So therefore, you’re causing self-inoculation and your patient oftentimes will be immunocompromised.

    02:45 Eosinophilic valve particles, the molluscum bodies, these are the ones that are then going to erupt and then cause self-type of inoculation.

    02:54 Please don’t forget that this is a virus.

    02:57 And if you take a look a look at the picture here, you’ll notice that this is umbilicated type of lesion that you’ll find.

    03:02 And if you take a look at the picture on the right, I want you to move from the right to the left, and in the middle of this on the right, you’ll find a body, a molluscum body in which upon self-inoculation, the virus itself could then spread into the local region causing further infection.

    03:25 Demographics: Children, immunosuppressed, maybe HIV, due to decreased cell mediated immunity Look for or think of immunocompromised patient if it’s in an adult, possibly children as well.

    03:40 Treatment: A destructive nature, is similar to warts, and LN2, you have your cantharidin, imiquimod, and topical steroids.

    03:50 You want to kind of treat this like what you would with HPV.

    03:53 Viruses, both of these are.

    03:55 Hence, you’ll notice that there is parallel in terms of management.

    About the Lecture

    The lecture Erysipelas and Molluscum Contagiosum by Carlo Raj, MD is from the course Infectious Skin Diseases. It contains the following chapters:

    • Erysipelas
    • Molluscum Contagiosum

    Included Quiz Questions

    1. Streptococcus A infection
    2. Cellulitis
    3. Stasis dermatitis
    4. Lymphangitis
    5. Pox virus infection
    1. Molluscum contagiosum
    2. Erysipelas
    3. Cellulitis
    4. Dermatitis
    5. Impetigo
    1. Molluscum contagiosum
    2. Erysipelas
    3. Impetigo
    4. Stasis dermatitis
    5. Folliculitis

    Author of lecture Erysipelas and Molluscum Contagiosum

     Carlo Raj, MD

    Carlo Raj, MD

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    what about...?
    By Laurent E. on 29. May 2017 for Erysipelas and Molluscum Contagiosum

    Interesting but a little light on my point of view. I am a resident working in France to become an emergency doctor and honestly i would have enjoy to have a differential diagnosis guide between erysipelas and DVT for instance or other similar looking skin disorders. Often receiving elderly patients at emergency, it is sometimes hard do make a difference (clinically i mean) between erysipelas and "ocre dermite" also called purpuric angiodermatitis, part of post thrombotic syndrome. What about the "portal of entry" in erysipelas we have to look for? what about the difference in aspect between cellulitis and erysipelas, one having more delimited and visible border than the other? Anyway thank you for this lecture :)