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erysipelas: dermal (analogous to urticaria)
cellulitis: subcutaneous (analogous to angioedema)
| • | an infection of the dermis and subcutaneous tissue |
| • | adults: group A strep, staph aureus |
| • | children (<3 years old): H. influenzae type B |
| • | lupus patient on prednisone and not responding to antibiotics: cryptococcus |
treatment:
| • | adult: penicillinase resistant penicillin |
| • | diclox 500-1000mg PO QID |
| • | Clinda is good for strep but doxy and sulfa not (and most cellulitis is strep) |
cryptococcus cellulitis:
| • | classic teaching = only in patients immunocompromised secondary to glucocorticoids |
| • | other immunocompromised patients (e.g. AIDS, cancer) – diffuse or nodular cryptococcus |
| • | definitive bacteriologic diagnosis is difficult to obtain |
| • | culture of needle aspirate, skin biopsy or blood usually negative |
| • | patients often appear worse in the first 1 or 2 days of antimicrobial therapy (probably secondary to dying organism suddenly releasing enzymes) |
recurrence:
| • | each attack probably causes some lymphatic damage from inflammation and scarring, which increases likelihood of further episodes |
| • | treat any predisposing conditions to prevent recurrence (tinea pedis, excema, dry skin) |
| • | if recurrences continue --> prophylactic antibiotics: IM benzathine PCN Q month, or oral PCN or erythromycin for 1 week each month |
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