Erysipelas: evolution under treatment, complications.

Objective - The authors studied the evolution and the complications of lowe r limb erysipelas under antibiotherapy. Method - The following parameters were studied in literature over the last 20 years (keyword = erysipelas): percentage of favorable course, delay for cure, local or systemic complications, prognostic factors, and mortality. Results - Data was only available in series of hospitalized patients. The l ower limbs were the exclusive or the most frequently involved areas. Under systemic antibiotherapy, the overall efficacy rates reached 76-84%, with ap yrexia within 24 to 48 h, and regression of local symptoms within 4 to 6 da ys. The median hospital stay was 10-13 days. A longer hospital stay was obs erved for: older patients, associated diseases, longer duration of illness prior to admission, and presence of a leg ulcer. Complications were observe d: abscess or superficial necrosis (3-12%), deep thrombophlebitis in 1.4% o f retrospective studies vs. 2.6-15% in prospective series. Mortality was lo w (0.5%) due to systemic complications more than to the severity of local s ymptoms. Relapse was frequent (12-25%). Discussion - The unavailability of data concerning outpatients limits the f ormulation of valid conclusions. Nevertheless the medical course was favora ble (80%) with apyrexia within 2 days, and absence of local symptoms within 4 to 6 days. Mortality or longer duration of hospital stay was linked to a ge or to associated diseases. The risk of deep thrombophlebitis was rare in absence of predisposing factors. Systematic prevention should be suggested and care given to local predisposing factors responsible for frequent recu rrent forms. (C) 2000 Editions scientifiques et medicales Elsevier SAS.