Skin and soft-tissue infections (SSTIs) are routinely encountered by physicians in the office setting and can vary in both clinical presentation and severity. Erysipelas is a more superficial SSTI involving the dermal lymphatics; cellulitis is a deeper infection extending into the deep dermis and subcutaneous tissues.

ERYSIPELAS

Clinical Manifestations

Erysipelas is a superficial SSTI with dermal lymphatic involvement and a distinct clinical presentation. The legs are the most common affected sites, but erysipelas can occur anywhere on the body. Young, elderly, and immunocompromised patients are particularly susceptible to erysipelas, especially if predisposing factors such as venous insufficiency, lymphedema, obesity, or any epidermal defect that impairs barrier function (eg, ulcers, operative or traumatic wounds, fissures) exist. Erysipelas is more common in older women and young men.

Erysipelas classically presents as a tender, sharply demarcated, bright-red edematous plaque with a raised, indurated advancing border (Figure 21.1). Abrupt onset of fever, chills, and malaise may precede skin disease by a few hours to a day. Some patients have associated regional lymphadenopathy with or without lymphatic streaking, in addition to edema with possible bullae formation.

Because erysipelas can produce lymphatic obstruction, it tends to recur in areas of earlier infection. Such recurrences are the most common complication occurring in approximately 30% of cases. Other complications including sepsis and progression to deep cellulitis are uncommon and are usually restricted to debilitated patients with underlying diseases.