Steroids can slightly reduce healing time and antibiotic duration in patients with erysipelas. You can prescribe prednisone 30 mg PO and taper over 8 days.4,12
Be sure to treat underlying predisposing conditions such as tinea pedis, venous eczema, and trauma sites. Encourage supportive measures, such as elevating the affected extremity, as well.
Improvement in a few days. Patients with erysipelas typically show improvement in 24 to 48 hours of beginning antibiotic therapy. Don’t be too quick to consider antibiotic failure in patients with worsening erythema after initiating antimicrobial therapy; this may be related to the destruction of pathogens that release enzymes (including deoxyribonuclease B [DNase B] and hyaluronidase) that increase local inflammation.
A good outcome for the patient
The patient was hospitalized and received cefazolin 1 g IV every 8 hours for 3 da ys. She was discharged on cephalexin 500 mg PO, every 6 hours for 7 days, with excellent results. FIGURE 2 shows the patient 4 days after she finished taking the cephalexin.
FIGURE 2
A few days, a big difference
The patient received cefazolin 1 g IV every 8 hours for 3 days, followed by oral cephalexin 500 mg every 6 hours for 7 days. This photo shows the patient 4 days after she finished taking the cephalexin.
CORRESPONDENCE Felix B. Chang, MD, Leominster Community Health Connections Family Health Center, 14 Manning Ave, Suite 402, Leominster, MA 01453; changf@ummhc.org.