Erysipelas in Darker Skin

00:00 Welcome to our lecture on erysipelas.

00:05 What is erysipelas? It's a bacterial skin infection involving the upper dermis that typically extends into the superficial cutaneous lymphatics. If one looks at epidemiology, you usually see isolated cases, although epidemics have been reported.

00:25 It's more common in women, infants and young children and elderly patients. It is caused by the beta hemolytic streptococcus.

00:37 However, if it occurs on the face, it's usually due to Streptococcus A on the lower extremities, it's usually due to non-group A streptococcal. What are some of the risk factors? Lymphatic obstruction or edema from whatever cause.

00:55 Saphenous vein grafting in lower extremities and sometimes pose a radical mastectomy.

01:02 Some patients with immunodeficiency are also at high risk and as well as arteriovenous insufficiency.

01:12 The clinical manifestations of patients with reciprocates It predominantly affects the legs at 80%, followed by the face in 20% of patients.

01:25 Clinically presents with small erythematous patch, which becomes dull red or grayish depending on the skin color.

01:35 Then it can become an indurated tense and shiny plaque.

01:41 There's usually clear demarcation between involved and uninvolved tissue, unlike cellulitis, if it occurs on the face, usually there is involvement of the ear and one may see a butterfly rash involving the face. Systemic manifestations include fever, chills, malaise, and headache. Some of the complications of erysipelas include lymphedema, bacteremia, meningitis, and septicemia. So how do we diagnose erysipelas? It is usually based on the clinical history and physical examination.

02:21 Secondly, swab for microscopy and culture and sensitivity should be undertaken. Serologic testing for beta hemolytic strep in cases of recurrent erysipelas is recommended.

02:36 Some of the differential diagnoses include.

02:39 Necrotizing fasciitis, which involves deeper tissue, particularly the muscle fascia, and overlying subcutaneous fat.

02:48 The second differential is cellulitis.

02:51 Here we remember that the borders are not well defined.

02:55 This indicates a deeper infection.

02:58 There is no ear involvement because the pinna lacks deeper dermis and subcutaneous tissue. Contact dermatitis is another differential, but here you see pruritic lesions that are generally limited to the site of contact. How do we manage these patients with erysipelas? We use oral antibiotics for about 5 to 6 days.

03:21 And these the penicillins like penicillin V or amoxicillin are used to treat erysipelas. Of course, cephalosporins can also be an option. In severe cases we use IV antibiotics.

03:38 And of course symptomatic treatment in some patients who may need it.