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Updated: Sep 3 2017


  • Snapshot
    • A 70-year-old man presents with a pain on the side of his left foot. He has had long-standing tinea pedis of his left foot that did not respond to previous treatments. About a week ago, he noticed redness of his left foot. On physical exam, there is a 5 cm bright pink, warm, and tender well-demarcated plaque. He is given oral antibiotics.
  • Introduction
    • Clinical definition
      • bacterial infection involving the upper dermis and cutaneous lymphatics
        • often from S. pyogenes
      • from superficial involvement of skin to deep
        • impetigo (very superficial skin infection)
        • erysipelas (upper dermis and cutaneous lymphatics)
        • cellulitis (deeper dermis and subcutaneous tissues)
    • Epidemiology
      • demographics
        • common in infants, children, and older adults
      • risk factors
        • existing skin injury
        • lymphedema
        • venous insufficiency
        • diabetes
        • hypertension
        • prior streptococcal throat infection
        • tinea pedis
    • Etiology
      • S. pyogenes
        • most common
      • S. aureus
    • Pathogenesis
      • pre-existing injury in skin can act as entry portal for bacteria
    • Prognosis
      • recurs in 10-40% of cases
  • Presentation
    • Symptoms
      • painful and tense skin
    • Physical exam
      • well-defined bright pink and erythematous plaque
        • raised above level of surrounding normal tissue
        • clear line between involved and uninvolved tissue
        • warm
  • Studies
    • Labs
      • none needed
    • Diagnosed clinically
  • Differential
    • Cellulitis
      • deeper involvement of skin and soft tissues
      • there is often an overlap and may not be distinguished clinically from cellulitis
  • Treatment
    • Conservative
      • elevate affected area
        • indications
          • for all patients
    • Medical
      • penicillins
        • indications
          • for mild infection
      • cephalosporins
        • indications
          • if there is contraindication to penicillin
  • Complications
    • Sepsis
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