Differentiating erysipelas from other diseases: Difference between revisions
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| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Cellulitis]]''' | | style="padding: 5px 5px; background: #DCDCDC;" |'''[[Cellulitis]]''' | ||
| style="padding: 5px 5px; background: #F5F5F5;" |Presents with nearly identical symptoms to Erysipelas, and is also usually caused by ''[[Streptococcus]]'' or ''[[ | | style="padding: 5px 5px; background: #F5F5F5;" |Presents with nearly identical symptoms to Erysipelas, and is also usually caused by ''[[Streptococcus]]'' or ''[[Staphylococcus]]'' [[bacteria]].<ref name="urlCellulitis: MedlinePlus Medical Encyclopedia">{{cite web |url=https://medlineplus.gov/ency/article/000855.htm |title=Cellulitis: MedlinePlus Medical Encyclopedia |format= |work= |accessdate=}}</ref>Differentiates from Erysipelas in that it manifests beneath the [[epidermis]] in the [[dermal]] layer of the [[skin]]; infection can spread to the [[subcutaneous]] [[fat]], [[bones]], [[joints]] and [[muscles]] of the affected area. The area of [[inflammation]] is not as sharply visibly demarcated as those characteristic of Erysipelas, due to the deeper manifestation in the skin. Can lead to worse complications than Erysipelas, including [[osteomyelitis]], [[lymphangitis]], [[endocarditis]], and [[meningitis]]. | ||
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| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Necrotizing fasciitis]]''' | | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Necrotizing fasciitis]]''' | ||
Revision as of 17:45, 19 September 2016
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.
Overview
Erysipelas must be differentiated from other inflammatory dermatological conditions that present with pain, erythema, edema, and blisters of the skin - in conjunction with other systemic conditions such as fever, chills, fatigue, headache, and vomiting.
Differentiating Erysipelas from other Diseases
Erysipelas must be differentiated from other inflammatory dermatological conditions that present with pain, erythema, edema, and blisters of the skin - in conjunction with other systemic conditions such as fever, chills, fatigue, headache, and vomiting.[1]
| Disease | Findings |
|---|---|
| Cellulitis | Presents with nearly identical symptoms to Erysipelas, and is also usually caused by Streptococcus or Staphylococcus bacteria.[2]Differentiates from Erysipelas in that it manifests beneath the epidermis in the dermal layer of the skin; infection can spread to the subcutaneous fat, bones, joints and muscles of the affected area. The area of inflammation is not as sharply visibly demarcated as those characteristic of Erysipelas, due to the deeper manifestation in the skin. Can lead to worse complications than Erysipelas, including osteomyelitis, lymphangitis, endocarditis, and meningitis. |
| Necrotizing fasciitis | Presents with more severe epidermal signs and symptoms than Erysipelas. Necrotizing fasciitis usually presents with erythema, edema, blisters, pain, suppuration, and clear signs of tissue necrosis (dark violet/blue to black in appearance).[3] Left untreated, necrotizing fasciitis usually leads to subcutaneous nerve destruction; a patient communicating more pain than is visibly apparent or manifested on the epidermis is indicative of nerve damage preceding or disproportionate to visible evidence.[4] In addition to antibiotics, immediate therapeutic surgery is required to prevent morbidity from Necrotizing fasciitis. |
| Shingles | Presents with itching, pain, and tingling on a single side of the body or face, which will develop into a rash with blisters. It can also present with fever. chills, headache, and nausea.[5]. Differentiated from Erysipelas by its cause as Varicella zoster virus infection and is usually self-limited; antiviral therapy and analgesics are indicated to shorten the duration and severity of symptoms, which will usually self-resolve within 7-10 days. Recognition and diagnosis of shingles is important to prevent complications, including postherpetic neuralgia.[6] |
| Angioedema | An edematous condition that involves swelling occurring below the epidermis, including the dermis and mucous membranes.[7]. Angioedema usually presents with edema near the eyes and lips, as well as hands, feet, and throat.[8]. Can present similarly to Erysipelas if epidermal welts and blisters form in the regions of edema, as well as cause abdominal pain.[9] Differentiates from Erysipelas in that the cause is primarily an allergic reaction from a variety of possible causes, including pollen/food/medication. While angioedema is usually self-limited and will resolve itself upon removing exposure to the allergenic cause, treatment with antihistamines, epinephrine, or corticosteroids must be administered to prevent life-threatening complications, including asphyxiation if the edema occurs in the throat.[9] |
| Contact dermatitis | An inflammatory condition of the epidermis as a result of direct contact with an allergen or irritant. It is similar to Erysipelas due to the usual presentation of erythema, blisters, itching, pain, and discharge. Differentiates from Erysipelas in that it is caused by an allergic response by contact to a specific surface or entity; there is no indication of bacterial infection. Common causes include chemicals from cosmetic and hygienic products, fabrics, metals, and animal hair or skin. Therapy involves avoiding the original cause and application of topical or oral corticosteroids and analgesics.[10] |
| Inflammatory breast cancer | Presents with edema and erythema of the breast, as well as itching, pain, and tenderness from the inflammation.[11]Differentiates from Erysipelas in that the inflammation is usually limited to the breast. Additional differential criteria include development of "ridges" on the breast, giving the appearance of an orange peel. It is urgent to differentiate and diagnose inflammatory breast cancer to begin immediate chemotherapy, radiation therapy, and/or surgery when indicated. |
References
- ↑ Inghammar M, Rasmussen M, Linder A (2014). "Recurrent erysipelas--risk factors and clinical presentation". BMC Infect. Dis. 14: 270. doi:10.1186/1471-2334-14-270. PMC 4033615. PMID 24884840.
- ↑ "Cellulitis: MedlinePlus Medical Encyclopedia".
- ↑ "Necrotizing soft tissue infection: MedlinePlus Medical Encyclopedia".
- ↑ Sadasivan J, Maroju NK, Balasubramaniam A (2013). "Necrotizing fasciitis". Indian J Plast Surg. 46 (3): 472–8. doi:10.4103/0970-0358.121978. PMC 3897089. PMID 24459334.
- ↑ "Shingles | Signs and Symptoms | Herpes Zoster | CDC".
- ↑ Kawai K, Gebremeskel BG, Acosta CJ (2014). "Systematic review of incidence and complications of herpes zoster: towards a global perspective". BMJ Open. 4 (6): e004833. doi:10.1136/bmjopen-2014-004833. PMC 4067812. PMID 24916088.
- ↑ Misra L, Khurmi N, Trentman TL (2016). "Angioedema: Classification, management and emerging therapies for the perioperative physician". Indian J Anaesth. 60 (8): 534–41. doi:10.4103/0019-5049.187776. PMC 4989802. PMID 27601734.
- ↑ "Angioedema: MedlinePlus Medical Encyclopedia".
- ↑ 9.0 9.1 Bork K (2010). "Recurrent angioedema and the threat of asphyxiation". Dtsch Arztebl Int. 107 (23): 408–14. doi:10.3238/arztebl.2010.0408. PMC 2893523. PMID 20589206.
- ↑ "Contact dermatitis: MedlinePlus Medical Encyclopedia".
- ↑ "Inflammatory Breast Cancer - National Cancer Institute".