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Erysipelas and Molluscum Contagiosum

by Carlo Raj, MD

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    00:01 Topic here is erysipelas, caused by Strep A.

    00:13 Demographics of erysipelas: children or elderly with poor circulation.

    00:17 What does it look like? Bright red erythematous plaques rapidly advancing borders and profound edema and common in the face or lower extremity, Strep A infection, poor circulation, diabetics or children.

    00:33 Differential diagnoses for erysipelas: Classic cellulitis.

    00:39 Erysipelas is more superficial, cellulitis is deeper.

    00:43 Erysipelas demonstrates a brighter erythema and advances more rapidly than traditional cellulitis with the infection that you're thinking about notably, Strep A.

    00:54 Stasis dermatitis, here you’re thinking about lower legs and which there is insufficient circulation so maybe your patient has varicose veins if female and so there’s faulty vas 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.

    01:21 Now with that stasis commonly bilateral develops more insidiously than erysipelas.

    01:25 Remember erysipelas very rapid Strep A extremely red and the borders are advancing rather quickly.

    01:31 Stasis is not associated with systemic symptoms Strep A could be but take a look at the picture here, I’m showing you extremely erythematous type of lesion it's a Strep A infection and we call this as St. Vincent’s fire because of how incredibly fiery red this condition is.

    01:50 Management - oral antibiotics followed 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.

    02:06 Molluscum Contagiosum is a type of pox virus. Molluscum contagiosum virus.

    02:15 Morphology: Think of this as being kind like a volcano and so therefore this or the umbilicus so you have central umbilication and what ends up happening if you find these lesions on the skin, a papilesion 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 pox virus which is then spreading locally so therefore you're causing self-inoculation and your patient often times will be immunocompromised.

    02:48 Eosinophilic viral particles, the molluscum bodies, these are the ones that are then going to erupt and then cause self-type of inoculation.

    02:58 Please don’t forget that this is a virus.

    03:01 And if you take a look at the picture here you’ll notice that this is an umbilicated type of lesions that you find 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.

    03:27 Demographics - children, immunosuppressed maybe HIV due to decreased cell mediated immunity.

    03:36 Look for or think of immunocompromised patient if it’s an adult, possibly children as well.

    03:43 Treatment - a destructive nature is similar to warts and LN2 you have your cantharidin, imiquimod and topical steroids, you wanna kinda treat this like what you would with HPV viruses, both of these are hence and 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. Erysipelas
    2. Cellulitis
    3. Stasis dermatitis
    4. Lymphangitis
    5. Pox virus infection
    1. Molluscum contagiosum
    2. Erysipelas
    3. Cellulitis
    4. Shingles
    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 :)