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4. Skin diseases
Erysipela
E rysip ela is an acute n on - n ecrotisin g h yp od erm al in fection , d ue to g roup A
strep tococcus. C om m on in ad ults, rare in child ren .
Clinical features
– P ain ful, in flam m atory, oed em atous p laq ue on a low er lim b, h igh fever, p erip h eral
ad en op athies an d lym p han gitis).
– M ay occur on the face: bilateral, oed em atous p laq ues, w ith p erip heral sw ellin g.
– L ook for a cutan eous p ortal of en try: ulcer, w oun d , in tertrigo.
– L ocal com p lication s: m ost com m on ly sup erficial abscess, som etim es d eep abscess4
(secon d ary stap hylococcal in fection ), rarely d evelop s in to n ecrotisin g faciitis.
– R are gen eralised com p lication s: sep ticaem ia, acute glom erulon ep h ritis, erythem a
n od osum .
Treatment
– benzylpenicillin procaine IM
C hild ren : 5 0 0 0 0 IU / k g on ce d aily
A d ults: 1 .5 M I U on ce d aily
un til th e fever d isap p ears an d th ere is clin ical im p rovem en t, th en ch an ge to oral
treatm en t to com p lete 7 to 1 0 d ays of treatm en t w ith:
phenoxymethylpenicillin (penicillin V) P O
C hild ren un d er 1 year: 2 5 0 m g/ d ay in 4 d ivid ed d oses
C hild ren from 1 to 5 years: 5 0 0 m g/ d ay in 4 d ivid ed d oses
C hild ren from 6 to 1 2 years: 1 g/ d ay in 4 d ivid ed d oses
A d ults: 2 g/ d ay in 4 d ivid ed d oses
or
amoxicillin P O: 5 0 m g/ k g/ d ay in 2 or 3 d ivid ed d oses
F or p atien ts allergic to p en icillin : erythromycin P O
C hild ren : 5 0 m g/ k g/ d ay in 2 or 3 d ivid ed d oses for 7 to 1 0 d ays
A d ults: 3 g/ d ay in 3 d ivid ed d oses for 7 to 1 0 d ays
– H osp italise p atien ts w h o sh ow m ark ed g en eralised sig n s, sig n s of local
com p lication s, p atien ts in p oor gen eral con d ition (chron ic d isease, the eld erly) or if
there is a risk of n on -com p lian ce d urin g outp atien t treatm en t.
– Note: oth er bacteria (Staphylococcus aureus, G ram n egative bacteria) m ay cause acute
cellulitis resem blin g erysip ela. I n th e even t of treatm en t failure w ith p en icillin ,
con sid er these in fection s an d chan ge to amoxicillin/ clavulanic acid (co-amoxiclav).
– F or all p atien ts:
•B ed rest w ith the affected leg elevated .
•N on - steroid al an ti- in flam m atory d rugs ( N S A I D ) are con tra- in d icated ( risk of
n ecrotisin g fasciitis).
•T reat the p ortal of en try (ulcer, w oun d , in tertrigo).
•C heck for p rotein uria, on reagen t strip , 3 w eek s after the in fection .
107
Erysipela
E rysip ela is an acute n on - n ecrotisin g h yp od erm al in fection , d ue to g roup A
strep tococcus. C om m on in ad ults, rare in child ren .
Clinical features
– P ain ful, in flam m atory, oed em atous p laq ue on a low er lim b, h igh fever, p erip h eral
ad en op athies an d lym p han gitis).
– M ay occur on the face: bilateral, oed em atous p laq ues, w ith p erip heral sw ellin g.
– L ook for a cutan eous p ortal of en try: ulcer, w oun d , in tertrigo.
– L ocal com p lication s: m ost com m on ly sup erficial abscess, som etim es d eep abscess4
(secon d ary stap hylococcal in fection ), rarely d evelop s in to n ecrotisin g faciitis.
– R are gen eralised com p lication s: sep ticaem ia, acute glom erulon ep h ritis, erythem a
n od osum .
Treatment
– benzylpenicillin procaine IM
C hild ren : 5 0 0 0 0 IU / k g on ce d aily
A d ults: 1 .5 M I U on ce d aily
un til th e fever d isap p ears an d th ere is clin ical im p rovem en t, th en ch an ge to oral
treatm en t to com p lete 7 to 1 0 d ays of treatm en t w ith:
phenoxymethylpenicillin (penicillin V) P O
C hild ren un d er 1 year: 2 5 0 m g/ d ay in 4 d ivid ed d oses
C hild ren from 1 to 5 years: 5 0 0 m g/ d ay in 4 d ivid ed d oses
C hild ren from 6 to 1 2 years: 1 g/ d ay in 4 d ivid ed d oses
A d ults: 2 g/ d ay in 4 d ivid ed d oses
or
amoxicillin P O: 5 0 m g/ k g/ d ay in 2 or 3 d ivid ed d oses
F or p atien ts allergic to p en icillin : erythromycin P O
C hild ren : 5 0 m g/ k g/ d ay in 2 or 3 d ivid ed d oses for 7 to 1 0 d ays
A d ults: 3 g/ d ay in 3 d ivid ed d oses for 7 to 1 0 d ays
– H osp italise p atien ts w h o sh ow m ark ed g en eralised sig n s, sig n s of local
com p lication s, p atien ts in p oor gen eral con d ition (chron ic d isease, the eld erly) or if
there is a risk of n on -com p lian ce d urin g outp atien t treatm en t.
– Note: oth er bacteria (Staphylococcus aureus, G ram n egative bacteria) m ay cause acute
cellulitis resem blin g erysip ela. I n th e even t of treatm en t failure w ith p en icillin ,
con sid er these in fection s an d chan ge to amoxicillin/ clavulanic acid (co-amoxiclav).
– F or all p atien ts:
•B ed rest w ith the affected leg elevated .
•N on - steroid al an ti- in flam m atory d rugs ( N S A I D ) are con tra- in d icated ( risk of
n ecrotisin g fasciitis).
•T reat the p ortal of en try (ulcer, w oun d , in tertrigo).
•C heck for p rotein uria, on reagen t strip , 3 w eek s after the in fection .
107
