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Open Access Research article

Recurrent erysipelas - risk factors and clinical presentation

Malin Inghammar12*, Magnus Rasmussen1 and Adam Linder13

Author Affiliations

1 Department of Clinical Sciences, Division of Infection Medicine, Klinikgatan 1, Skåne University Hospital, Lund, Lund SE-221 85, Sweden

2 The Division of Health Surveillance and Research, Statens Serum Institut, 5 Artillerivej, Copenhagen DK-2300, Denmark

3 Division of Critical Care Medicine, Centre for Heart Lung Innovation, St. Paul’s Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada

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BMC Infectious Diseases 2014, 14:270  doi:10.1186/1471-2334-14-270

Published: 18 May 2014

Abstract

Background

Erysipelas 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.

Methods

Medical 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.

Results

Erysipelas 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.

Conclusions

In 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.

Keywords:
Erysipelas; Skin infection; Recurrent; Risk factor