Abstract
BackgroundErysipelas is a common infection that often recurs, but the impact of specific risk factors for reoccurrence remains elusive. In the present study we aimed at clarifying predisposing conditions for reoccurrence.MethodsMedical records were reviewed from all patients ≥18 years of age diagnosed with erysipelas at the Department of Infectious Diseases at Skåne University Hospital, Sweden, from January 2007 to February 2011. 502 patients were included, of which 357 were single episode erysipelas and 145 had recurrent erysipelas. These two groups were compared regarding underlying conditions and clinical presentation.ResultsErysipelas in the lower limbs had the greatest propensity of recurrence. The associations between underlying conditions and recurrence were largely depending on the site of erysipelas. Overall, the most prominent risk factor for recurrence was lymphedema and other conditions causing a chronic impairment of the defence against microbes. Conditions temporarily disrupting the skin barrier (e.g. a local wound or toe web intertrigo), although likely being risk factors for erysipelas per se, did not seem to predispose to repeated episodes. Individuals with recurrent erysipelas tended to seek medical attention earlier, and were less likely to be hospitalized or receive intravenous antibiotics, but there was no evidence of any difference in inflammatory reaction when taking confounding factors into account.ConclusionsIn this large cross-sectional study of over 500 patients with erysipelas, lymphedema was the most prominent risk factors for recurrence although the distribution of predisposing conditions varies depending on the site of erysipelas.
Highlights
Erysipelas is a common infection that often recurs, but the impact of specific risk factors for reoccurrence remains elusive
We aimed at assessing whether the clinical presentation in episodes of recurrent erysipelas differ from single episodes
Patient demographics During the study period, 601 patients were registered with the diagnosis of erysipelas
Summary
Erysipelas is a common infection that often recurs, but the impact of specific risk factors for reoccurrence remains elusive. Erysipelas is a common infection of the superficial layer of the skin, in contrast to cellulitis and necrotizing fasciitis, which involve the subcutaneous tissue. It has an estimated incidence of 19–24 per 10,000 inhabitants in European countries [1,2]. Prophylaxis with penicillin V is sometimes recommended, but treatment criteria are not well defined This common infection causes both suffering and medical expenses that should motivate appropriate prevention, which should be directed to patients with the greatest risk [1]. We hypothesized that patients with single episode erysipelas and patients with recurrent erysipelas differs regarding general characteristics and we aimed to clarify risk factors for erysipelas recurrence. We aimed at assessing whether the clinical presentation in episodes of recurrent erysipelas differ from single episodes
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