Erysipelas, or St. Anthony's fire, is cellulitis and lymphangitis of the skin caused by group A, b-hemolytic streptococci. It is frequently accompanied by fever, chills, malaise, headache, and vomiting.
The rash is characterized by local redness, heat, swelling, and a raised, indurated border. There is marked involvement of the superficial dermal lymphatics. The rash starts as an erythematous plaque that rapidly enlarges by peripheral extension. At first, it is scarlet, hot, brawny, swollen, and tender. The edge is raised and sharply demarcated. The rash can vary in appearance from a transient hyperemia to intense inflammation, vesiculation, and bulla formation. The face is the most frequent site. A skin wound, fissure, or ulcer may act as a portal of entry.
Diagnosis is made on clinical grounds, although aspiration of the leading edge of the lesion will frequently demonstrate streptococci. A brief course of parenteral penicillin is usually warranted because of the rapid advancement of the infection, the acutely toxic state of the patient, and the possibility of suppurative complications. Rapid clinical response is usually obtained. Erythromycin may be used in patients unable to take penicillin.
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