Diagnosis: Erysipelas
A 45-year-old male presented with a 2-day history of a sharply demarcated, hot, tender plaque on the right cheek, accompanied by fever and chills. Examination revealed erythema and edema localized to the facial area, suggesting a bacterial skin infection likely due to streptococcal species.
A 45-year-old male presented to the clinic with a 2-day history of a painful, swollen area on his right cheek. He described the lesion as progressively worsening and associated with fever, chills, and malaise. On examination, the affected area demonstrated a sharply demarcated, erythematous plaque with edema and tenderness to palpation. There were no pustules or vesicles noted, and systemic examination was otherwise unremarkable.Lesion characteristics: Well-defined borders and significant tenderness.Systemic signs: Fever and chills present.Location: Primarily on the cheek, with no involvement of surrounding structures.Absence of other dermatological signs: No evidence of systemic dermatitis or other skin lesions.
The patient reported that the onset of the lesion was sudden, with no preceding trauma or insect bites. He denied any recent travel or exposure to sick contacts. His medical history was significant for hypertension and type 2 diabetes, both well-controlled with medication. He has no known drug allergies and does not take any immunosuppressive medications. Family history was unremarkable for skin diseases, but he mentioned a history of recurrent skin infections in childhood.Onset: Sudden onset over 2 days.Triggers: No known triggers or injuries.Past medical history: Hypertension and type 2 diabetes.Social history: No recent travel or exposure to infectious diseases.Family history: No significant dermatological conditions.
Acute / First-Line ManagementAntibiotic therapy: Initiate with oral penicillin VK 500 mg three times daily or clindamycin 300 mg three times daily for those allergic to penicillin. Duration of treatment is typically 7-10 days.Analgesics: Provide acetaminophen or ibuprofen for pain management and fever reduction.Supportive care: Advise rest and hydration to support recovery.Workup and Diagnostic ConfirmationClinical diagnosis: Diagnosis is primarily clinical based on characteristic findings.Microbial cultures: Skin swabs may be obtained if there is suspicion of mixed infection or poor response to initial therapy.Blood tests: Complete blood count may be helpful to evaluate for leukocytosis.Long-Term ManagementPreventive measures: Educate the patient on skin care and hygiene to prevent recurrence.Follow-up: Schedule follow-up visit within 1-2 weeks to assess response to treatment.Consideration of underlying conditions: Evaluate for potential underlying immunocompromised states if recurrent episodes occur.
Cellulitis: Generally has less defined borders and may involve deeper layers of skin and subcutaneous tissue, often with systemic symptoms.Contact dermatitis: Typically presents with vesicles or erosions, often in response to an allergen or irritant, and lacks systemic symptoms.Facial abscess: Presents with fluctuant areas, often requiring drainage, and may be accompanied by systemic signs of infection.Herpes simplex virus infection: Characterized by vesicular lesions and often preceded by prodromal symptoms such as tingling or burning.Impetigo: Commonly presents with crusted lesions, particularly in children, and often has a more superficial involvement.Acne vulgaris: Typically presents with comedones and inflammatory papules, not usually associated with systemic symptoms.Stasis dermatitis: Associated with venous insufficiency and presents with edema, erythema, and scaling, often over the lower extremities.Drug eruption: Can present with erythematous plaques but usually accompanied by a history of medication exposure.
High-Yield PearlsClinical presentation: Erysipelas is characterized by well-defined, raised borders and systemic symptoms such as fever.Pathogen: Most cases are caused by Streptococcus pyogenes, which requires appropriate antibiotic coverage.Diagnosis: Primarily clinical; laboratory tests are adjunctive and not routinely needed.Treatment duration: Typical antibiotic therapy lasts 7-10 days, depending on clinical response.Complications: If untreated, erysipelas can progress to cellulitis or systemic infections.Prompt recognition and treatment of erysipelas can prevent complications and ensure patient recovery.
Tags: erysipelas, streptococcal