Bacterial acute non necrosing cellulitis (erysipelas) in adult

Erysipelas is defined by a sudden onset (with fever) preceding the appearance of a painful, infiltrated, erythematous plaque, accompanied by regional lymphadenopathy. It is usually localized on the lowerlimbs, but it can occur on the face. It is due to beta-hemolytic streptococcus A and more rarely to staphylococcus aureus. It is important to establish the diagnosis and eliminate the non-bacterial causes ofinflammatory edema. The other diagnoses frequently found are contact eczema, acute arthritis, bursitis, inflammatory flare-up of chronic dermohypodermitis of venous origin, flare-up of chronic multifactorialeczema (venous insufficiency, vitamin deficiencies, senile xerosis and/or contact eczema), rare familialperiodic fevers, rare neutrophilic dermatoses or eosinophilic cellulitis. It is necessary to identify signs ofseverity that would justify hospitalization. In front of a typical acute bacterial dermohypodermitis and inthe absence of comorbidity, no additional investigation is necessary. Systematic blood cultures have lowprofitability. Locoregional causes must be identified in order to limit the risk of recurrence which remainsthe most frequent complication. In uncomplicated erysipelas, amoxicillin is the gold standard; treatment with oral antibiotic therapy is possible if there is no sign of severity or co-morbidity (diabetes, arteritis, cirrhosis, immune deficiency) or an unfavorable social context. In case of allergy to penicillin, pristinamycin or clindamycin should be prescribed. Prophylactic antibiotic therapy with delayed penicillin isrecommended in the event of recurrent erysipelas. (C) 2020 Societe Nationale Francaise de Medecine Interne (SNFMI). Published by Elsevier Masson SAS. Allrights reserved.