Erysipelas v Jessner lymphocytic

ERYSIPELAS
Clinical features

  • Acute bacterial infection of the dermis and upper subcutaneous tissue.
  • Usually caused by group-A beta-haemolytic streptococcus.
  • Patient is ill with high fever and rigors.
  • Tender, erythematous, oedematous, well-demarcated area of skin that may blister.
  • Usually unilateral and occurs most commonly on the leg and face.

Management

  • Urgent treatment is required - phenoxymethylpenicillin or erythromycin, 500mg six-hourly, for 10-14 days.
  • Long-term prophylactic antibiotics may be required for those with recurrent attacks.

JESSNER LYMPHOCYTIC INFILTRATE
Clinical features

  • Benign chronic T-cell infiltrative disorder.
  • Red/brown papules 2-20mm in diameter that enlarge to form well-demarcated red plaques.
  • Usually symptomless but may burn or itch.
  • Single or multiple.
  • Frequently on the face but may occur on the trunk.

Management

  • Spontaneous resolution may occur.
  • Cosmetic camouflage, topical or intralesional corticosteroids and hydroxychloroquine are sometimes helpful.
  • Contributed by Dr Jean Watkins, a GP in Ringwood, Hampshire.

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