This document provides tips for using a PowerPoint presentation on erysipelas: 1. The presentation can be freely downloaded, edited, and modified. Blank slides are included to engage students by asking what they know about each topic before presenting additional information. 2. The presentation follows an active learning approach, showing blank slides, asking questions, and then presenting content over three revisions to reinforce learning. 3. The presentation is also useful for self-study, with notes providing references and bibliography.

1. Tips on using my ppt.
1. You can freely download, edit, modify and put your
name etc.
2. Don’t be concerned about number of slides. Half the
slides are blanks except for the title.
3. First show the blank slides (eg. Aetiology ) > Ask
students what they already know about ethology of
today's topic. > Then show next slide which enumerates
aetiologies.
4. At the end rerun the show – show blank> ask questions >
show next slide.
5. This will be an ACTIVE LEARNING SESSION x
three revisions.
6. Good for self study also.
7. See notes for bibliography.

2. Introduction & History.

3. Introduction & History.
• Erysipelas is a bacterial skin infection
involving the upper dermis that
characteristically extends into the
superficial cutaneous lymphatics.
• It is a tender, intensely erythematous,
indurated plaque with a sharply demarcated
border. Its well-defined margin can help
differentiate it from other skin infections
(eg, cellulitis).
•

4. Introduction & History.
• In the Middle Ages it was referred to as St.
Anthony's fire.
• Historically, erysipelas occurred on the
face, but cases today most often involve the
legs.

6. Etiology

7. Etiology
• Idiopathic
• Congenital/Genetic
• Traumatic
• Infections /Infestation
• Autoimmune
• Neoplastic (Benign/Malignant)
• Degenerative
• Iatrogenic

8. Etiology
• The group A streptococcal
bacterium Streptococcus pyogenes causes most of
the facial infections;
• lower extremity infections are now being caused
by non–group A streptococci.
• The role of Staphylococcus aureus, and
specifically methicillin-resistant S
aureus (MRSA), remains controversial.
• Erysipelas in newborns , perineal and lower-trunk
erysipelas occurring in postpartum women.is often
caused by group B streptococci.

9. Pathophysiology

10. Pathophysiology
• Bacterial inoculation into an area of skin trauma is
the initial event in developing erysipelas
• Thus, local factors, such as venous insufficiency,
stasis ulcerations, inflammatory dermatoses,
dermatophyte infections, insect bites, and surgical
incisions, have been implicated as portals of
entry.
• The source of the bacteria in facial erysipelas is
often the host's nasopharynx, and a history of
recent streptococcal pharyngitis has been reported
in up to one third of cases..

11. Pathophysiology
• The infection rapidly invades and spreads through
the lymphatic vessels.
• This can produce overlying skin "streaking" and
regional lymph node swelling and tenderness.
• Immunity does not develop to the inciting
organism.
• Streptococcal toxins are thought to contribute to
the brisk inflammation that is typical of this
infection

12. Predisposing factors

13. Predisposing factors
• Lymphatic obstruction
or edema
• Saphenous vein
grafting in lower
extremities
• Status postradical
mastectomy
• Immunocompromise:
Including patients who
are diabetic or
alcoholic HIV.
•
• Arteriovenous
insufficiency
• Paretic limbs
• Nephrotic syndrome
• Vagrant lifestyle

14. Clinical Features

15. Clinical Features
• Demography
• Symptoms
• Signs
• Prognosis
• Complications

16. Demography

17. Demography
• Isolated cases are although epidemics have
been reported.
• The incidence declined throughout the mid-
20th century, possibly due to antibiotic
development, improved sanitation, and
decreased virulence.
• The change in distribution from the face to
the lower extremities is most likely related
to an aging population with risk factors such
as lymphedema.

18. Demography
• Erysipelas is somewhat more common in
European countries.
• all age groups, but infants, young children,
and elderly patients are most commonly
affected.
• Slightly more common in females.
• Occur at an earlier age in males

19. Symptoms

20. Symptoms
• Prodromal symptoms, such as malaise, chills, and
high fever.
• Pruritus, burning, tenderness, and swelling are
typical complaints.
• Muscle and joint pain
• Nausea
• Headache and other systemic manifestations of an
infectious process
• Associated comorbidities in erysipelas include
diabetes mellitus, as well as hypertension, chronic
venous insufficiency, and other cardiovascular
diseases.

21. Signs

22. Signs
• lower extremities in 80% of patients;
• face
• The patient may appear healthy or toxic
depending on the extent of infection.
• begins as a small erythematous patch that
progresses to a fiery-red, indurated, tense,
and shiny plaque.
• Step sign- classically a sharply raised
border with abrupt demarcation from
healthy skin .

23. Signs
• warmth, edema, and tenderness,
• overlying skin streaking and regional
lymphadenopathy
• vesicles and bullae, along with petechiae
and even frank necrosis

24. Differential Diagnosis

25. Differential Diagnosis
Erysipelas
• involving the upper
dermis and
lymphatics,
• Raised edges
• Milian's Ear Sign of
Erysipelas
Cellulitis
• involves the deeper
dermis and
subcutaneous fat
• Indistinct edges.
• Pinna is not affected.

26. Differential Diagnosis
• Acute Compartment
Syndrome
• Allergic Contact
Dermatitis
• Angioedema
• Angioneurotic edema
• Cutaneous
Manifestations of
Cholesterol Embolism
•
• Dermatophytid
• Erysipelas
carcinomatosum
• Erysipeloid
leishmaniasis
• Erythema Induratum
(Nodular Vasculitis)
• Erythema Nodosum
• Familial
Mediterranean Fever
•

27. Differential Diagnosis
• Granuloma Faciale
• Herpes Zoster
• Lyme borreliosis
• Necrotizing Fasciitis
• Relapsing
Polychondritis
• Scarlet Fever
• Stasis Dermatitis
• SLE
• Tuberculid leprosy
•

28. Prognosis

29. Prognosis
• Excellent.
• mortality rate of less than 1%
• Can be fatal when associated with
bacteremia in very young, elderly, or
immunocompromised patients.

30. Complications

31. Complications
• Uncommon
• Gangrene/amputation
• Chronic edema
• Scarring
• Bacteremia sepsis
• Scarlet fever
• Pneumonia
• Abscess
• Embolism
• Meningitis
• Death
• bursitis, osteitis,
arthritis, and
tendinitis.
• acute
glomerulonephritis,
endocarditis,
septicemia, and
streptococcal toxic
shock syndrome.
• elephantiasis nostras
verrucosa.

32. Investigations

33. Investigations
• Laboratory Studies
– Routine
– Special
• Imaging Studies
• Tissue diagnosis
– Cytology
• FNAC
– Histlogy

34. Diagnostic Studies

35. Diagnostic Studies
Imaging Studies
• X-Ray
• USG
• CT
• Angiography
• MRI
• Endoscopy
• Nuclear scan

36. Management

37. Management
• Penicillin
• A first-generation cephalosporin
• Clindamycin
• roxithromycin and pristinamycin
• The FDA approved 3 antibiotics,
– oritavancin(Orbactiv),
– dalbavancin(Dalvance),
– tedizolid(Sivextro),
for the treatment of acute bacterial skin and
skin structure infections.

38. Management
• Symptomatic treatment of aches and fever
• Hydration (oral intake if possible)
• Cold compresses
• Elevation and rest of the affected limb:
Recommended to reduce local swelling,
inflammation, and pain
• Saline wet dressings: Should be applied to
ulcerated and necrotic lesions and changed
every 2-12 hours, depending on the severity
of the infection

39. Operative Therapy

40. Operative Therapy
• Debridement is necessary only in severe
infections with necrosis or gangrene.

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