Artikel
Erysipelas at uncommon sites
Erysipele an ungewöhnlichen Lokalisationen
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Autoren
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M. Glatz
- Universitätsspital Zürich, Dermatologische Klinik, Zürich, Switzerland
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D. Degen
- Landesklinikum Wiener Neustadt, Abteilung für Dermatologie, Wiener Neustadt, Austria
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W. Aberer
- Medizinische Universität Graz, Universitätsklinik für Dermatologie und Venerologie, Graz, Austria
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L.E. French
- Universitätsspital Zürich, Dermatologische Klinik, Zürich, Switzerland
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R.R. Müllegger
- Landesklinikum Wiener Neustadt, Abteilung für Dermatologie, Wiener Neustadt, Austria
| Veröffentlicht: | 2. Juni 2010 |
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Gliederung
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Objective: To examine the characteristics of erysipelas at uncommon body sites.
Methods: From 2005–08, 1,425 patients with erysipelas were seen in 3 dermatologic centers. Patient files were retrospectively analyzed. Erysipelas was defined as sudden, expanding, sharply demarcated red swelling with fever and elevated CRP.
Results: Locations of erysipelas were as follows: lower leg 73%; face, 13%; arm, 6.7%; genitalia and trunk, 4.6%. In 8 patients (0.5%) (m:f=4:4; mean age 53.5yrs) erysipelas was located in the gluteal region, and in 31 cases (2.2%) (m:f=16:15; mean age 47yrs) exclusively on the thigh.Clinically, erysipelas of the buttocks had conspicuous irregular borders and a violaceous hue; vesicles in 2 and hemorrhages in 1 case. Risk factors were dermatitis including inverse psoriasis or acne in 5 patients and obesity and diabetes in 3 patients each. In 3 cases hip arthroplasty was performed ≥12mos earlier. In all of these 3 patients, erysipelas spread beyond the scar; and was symmetric in 1 patient with bilateral arthroplasty. Erysipelas of the thigh was clinically not different to that of common sites, and had no bullae or hemorrhages. Nine patients had inguinal lymphadenectomy a median of 13.5mos before (1–60mos); additional 17 patients had other surgical intervention, trauma, or arthropod bites directly previously at this site. All patients recovered completely with mostly betalactam antibiotics or clindamycin in standard regimens. Two patients with thigh manifestation experienced recurrences within the study period.
Conclusions: Erysipelas preferentially befalls the lower leg or face. It only exceptionally occurs on the buttocks or thigh despite a high frequency of potential risk factors (e.g. hip arthroplasty, lymphadenectomy). Erysipelas on the buttocks is often a late sequel after arthroplasty (due to lymphatic stasis). On the thigh it occurs any time after lymphadenectomy or as acute complication after a local injury. The route of the superficial lymphatic vessels could influence the clinical expression of erysipelas on the buttocks or thigh.
