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Karakonstantis S. Is coverage of S. aureus necessary in cellulitis/erysipelas? A literature review. Infection 2019; 48:183-191. [PMID: 31845187 DOI: 10.1007/s15010-019-01382-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 12/06/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Empirical treatment of patients with cellulitis/erysipelas usually targets both streptococci and methicillin-sensitive S. aureus (MSSA). However, the recommendation to empirically cover MSSA is weak and based on low-quality evidence. METHODS AND OBJECTIVE A systematic review was conducted in PubMed and clinical trial registries to assess the role of S. aureus in cellulitis/erysipelas and the need for empirical MSSA coverage. RESULTS Combined microbiological and serological data, and response to penicillin monotherapy suggest that streptococci are responsible for the vast majority of cases of cellulitis/erysipelas. However, most cases are non-culturable and the specificity of microbiological and serological studies is questionable based on recent studies using molecular techniques. According to epidemiological data and three randomized controlled trials, empirical coverage of methicillin-resistant S. aureus (MRSA) is not recommended for most patients, despite the high prevalence of MRSA in many areas. If MRSA is indeed not an important cause of uncomplicated cellulitis/erysipelas, then the same may apply to MSSA. Based on indirect comparison of data from clinical studies, cure rates with penicillin monotherapy (to which most MSSA are resistant) are comparable to the cure rates reported in many studies using wider-spectrum antibiotics. CONCLUSION Considering the limitations of microbiological studies in identifying the pathogens responsible for cellulitis/erysipelas, treatment needs to be guided by clinical trials. Trials comparing penicillin or amoxicillin monotherapy to MSSA-covering regimens are needed to definitively answer whether empirical coverage of MSSA is needed and to identify the subset of patients that can be safely treated with penicillin or amoxicillin monotherapy.
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Affiliation(s)
- Stamatis Karakonstantis
- Infectious Diseases Unit, School of Medicine, University of Crete, Voutes, Heraklion, Postal code 71110, Greece.
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Peterson RA, Polgreen LA, Sewell DK, Polgreen PM. Warmer Weather as a Risk Factor for Cellulitis: A Population-based Investigation. Clin Infect Dis 2019; 65:1167-1173. [PMID: 30059959 DOI: 10.1093/cid/cix487] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 05/30/2017] [Indexed: 11/14/2022] Open
Abstract
Background The incidence of cellulitis is highly seasonal and this seasonality may be explained by changes in the weather, specifically, temperature. Methods Using data from the Nationwide Inpatient Sample (years 1998 to 2011), we identified the geographic location for 773719 admissions with the primary diagnosis (ICD-9-CM code) of cellulitis and abscess of finger and toe (681.XX) and other cellulitis and abscess (682.XX). Next, we used data from the National Climatic Data Center to estimate the monthly average temperature for each of these different locations. We modeled the odds of an admission having a primary diagnosis of cellulitis as a function of demographics, payer, location, patient severity, admission month, year, and the average temperature in the month of admission. Results We found that the odds of an admission with a primary diagnosis of cellulitis increase with higher temperatures in a dose-response fashion. For example, relative to a cold February with average temperatures under 40° F, an admission in a hot July with an average temperature exceeding 90°F has 66.63% higher odds of being diagnosed with cellulitis (95% confidence interval [CI]: [61.2, 72.3]). After controlling for temperature, the estimated amplitude of seasonality of cellulitis decreased by approximately 71%. Conclusion At a population level, admissions to the hospital for cellulitis risk are strongly associated with warmer weather.
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Affiliation(s)
| | | | | | - Philip M Polgreen
- Departments of Internal Medicine and Epidemiology, University of Iowa, and.,The University of Iowa Health Ventures' Signal Center for Health Innovation, Iowa City
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Challener D, Marcelin J, Visscher S, Baddour L. Hospital costs for patients with lower extremity cellulitis: a retrospective population-based study. Hosp Pract (1995) 2017; 45:196-200. [PMID: 28944703 PMCID: PMC5935496 DOI: 10.1080/21548331.2017.1384690] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 09/22/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Hospital admissions for non-purulent lower extremity cellulitis (NLEC) are common and can be prolonged and costly. Newer treatment options and preventive strategies are expected to result in cost savings before implementation, but few studies have quantified the cost of conventional treatment. METHODS Using the Rochester Epidemiology Project, the incidence of NLEC in Olmsted County, MN in 2013 was 176.6 per 100,000 persons. The subset of patients who required hospitalization for NLEC in 2013 was determined. Hospital admissions were analyzed retrospectively using standardized cost analysis within several relevant categories. RESULTS Thirty-four patients had an average hospital length of stay of 4.7 days. The median total inpatient cost was $7,341. The median cost per day was $2,087, with 49% due to room and board. Antibiotics administered for treatment of NLEC contributed a median cost of $75 per day of hospitalization, and laboratory and imaging test costs were $73 and $44, respectively, per day of hospitalization. CONCLUSION Hospitalizations for NLEC can be costly and prolonged with room and board accounting for much of the cost. Therefore, newer management strategies should seek to reduce hospital length of stay and/or avoid inpatient admission to reduce cost.
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Affiliation(s)
| | - Jasmine Marcelin
- b Infectious Diseases , University of Nebraska Medical Center , Omaha , NE , USA
| | - Sue Visscher
- c Center for the Science of Healthcare Delivery, Mayo Clinic , Rochester , MN , USA
| | - Larry Baddour
- d Infectious Diseases , Mayo Clinic , Rochester , MN , USA
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Peterson RA, Polgreen LA, Cavanaugh JE, Polgreen PM. Increasing Incidence, Cost, and Seasonality in Patients Hospitalized for Cellulitis. Open Forum Infect Dis 2017; 4:ofx008. [PMID: 28480281 PMCID: PMC5414024 DOI: 10.1093/ofid/ofx008] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 01/27/2017] [Indexed: 01/24/2023] Open
Abstract
Using data from the National Inpatient Sample, 1998-2013, we show that hospitalizations for cellulitis have approximately doubled. Costs increased by 118% to $3.74 billion annually. In addition, hospitalizations for cellulitis are highly seasonal, peaking in summer months: incidence during the peak month of July is 35% higher than in February.
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Affiliation(s)
| | | | | | - Philip M Polgreen
- Internal Medicine, and.,Epidemiology, University of Iowa, Iowa City.,University of Iowa Health Ventures' Signal Center for Healthcare Innovation, Iowa City
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5
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Pitché P, Diatta B, Faye O, Diané BF, Sangaré A, Niamba P, Mandengue C, Kobengue L, Saka B, Diop A, Ly F, Dieng MT, Dicko A, Soumah MM, Cissé M, Kourouma SH, Kouassi YI, Boukari T, Akakpo S, Tchangaï-Walla K. [Risk factors associated with leg erysipelas (cellulitis) in sub-Saharan Africa: A multicentre case-control study]. Ann Dermatol Venereol 2015; 142:633-8. [PMID: 26364000 DOI: 10.1016/j.annder.2015.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 05/04/2015] [Accepted: 08/05/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Acute bacterial cellulitis of the leg (erysipelas) is a common problem involving considerable morbidity in dermatology practice in Africa. Previous studies conducted in Europe and North Africa have highlighted lymphoedema and toe-web intertrigo as independent factors associated with leg erysipelas. The aim of this case-control study was to identify risk factors associated with leg erysipelas in sub-Saharan Africa, within a different socio-economic and culture context. PATIENTS AND METHODS We conducted a prospective case-control study in hospital dermatology departments in 8 sub-Saharan African countries over a 12-month period (October 2013 to September 2014). Each case of acute leg cellulitis was matched with 2 controls for age (±5 years) and sex. We analysed the general and local factors. RESULTS During the study period, 364 cases (223 female, 141 male) were matched with 728 controls. The mean age was 42.15±15.15 years for patients and 42.11±36 years for controls. Multivariate analysis showed the following to be independent risk factors associated with leg erysipelas in our study: obesity (odds ratio [OR]=2.82 ; 95% confidence interval: 2.11-3.76), lymphoedema (OR=3.87, 95%CI: 2.17-6.89), voluntary cosmetic depigmentation (OR=4.29, 95%CI: 2.35-7.83), neglected traumatic wound (OR=37.2, 95%CI: 24.9-57.72) and toe-web intertrigo (OR=37.86, 95%CI: 22.27-64.5). CONCLUSION The results of this study confirms the major role of local risk factors (toe-web intertrigo, lymphoedema) previously identified in other geographical settings. However, the originality of our study consists of the identification of voluntary cosmetic depigmentation as a risk factor for leg erysipelas in sub-Saharan Africa.
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Affiliation(s)
- P Pitché
- Service de dermato-vénéréologie, CHU Sylvanus Olympio, université de Lomé, 08 BP 81056, Lomé 08, Togo.
| | - B Diatta
- Service de dermatologie, CHU Le Dantec, Dakar, université Cheik Anta Diop, Dakar, Sénégal
| | - O Faye
- Service de dermatologie, CNAM, Bamako, université de Bamako, Bamako, Mali
| | - B-F Diané
- Service de dermatologie-MST, CHU Donka, Conakry, université de Conakry, Conakry, Guinée
| | - A Sangaré
- Centre de dermatologie, CHU Treichville, université de Cocody, Cocody, Côte d'Ivoire
| | - P Niamba
- Service de dermatologie, CHU Yaldago Ouédraogo, Ouagadougou, université de Ouagadougou, Ouagadougou, Burkina Faso
| | - C Mandengue
- Service de dermatologie, clinique universitaire des Montagnes, Banganté, Cameroun
| | - L Kobengue
- Service de dermatologie, CHU de Bangui, université de Bangui, Bangui, Centrafrique
| | - B Saka
- Service de dermato-vénéréologie, CHU Sylvanus Olympio, université de Lomé, 08 BP 81056, Lomé 08, Togo
| | - A Diop
- Service de dermatologie, CHU Le Dantec, Dakar, université Cheik Anta Diop, Dakar, Sénégal
| | - F Ly
- Service de dermatologie, CHU Le Dantec, Dakar, université Cheik Anta Diop, Dakar, Sénégal
| | - M-T Dieng
- Service de dermatologie, CHU Le Dantec, Dakar, université Cheik Anta Diop, Dakar, Sénégal
| | - A Dicko
- Service de dermatologie, CNAM, Bamako, université de Bamako, Bamako, Mali
| | - M-M Soumah
- Service de dermatologie-MST, CHU Donka, Conakry, université de Conakry, Conakry, Guinée
| | - M Cissé
- Service de dermatologie-MST, CHU Donka, Conakry, université de Conakry, Conakry, Guinée
| | - S-H Kourouma
- Centre de dermatologie, CHU Treichville, université de Cocody, Cocody, Côte d'Ivoire
| | - Y-I Kouassi
- Centre de dermatologie, CHU Treichville, université de Cocody, Cocody, Côte d'Ivoire
| | - T Boukari
- Service de dermato-vénéréologie, CHU Sylvanus Olympio, université de Lomé, 08 BP 81056, Lomé 08, Togo
| | - S Akakpo
- Service de dermato-vénéréologie, CHU Sylvanus Olympio, université de Lomé, 08 BP 81056, Lomé 08, Togo
| | - K Tchangaï-Walla
- Service de dermato-vénéréologie, CHU Sylvanus Olympio, université de Lomé, 08 BP 81056, Lomé 08, Togo
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Reading the Red Ear. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2013. [DOI: 10.1097/ipc.0b013e31828875c5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Krasagakis K, Samonis G, Valachis A, Maniatakis P, Evangelou G, Tosca A. Local complications of erysipelas: a study of associated risk factors. Clin Exp Dermatol 2010; 36:351-4. [PMID: 21198795 DOI: 10.1111/j.1365-2230.2010.03978.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Local complications of erysipelas include haemorrhagic, bullous, abscessing and necrotic lesions. The risk factors predisposing patients to local complications are not fully known. AIM To examine local complications of erysipelas and to identify possible risk factors predisposing to their appearance. METHODS Medical records from all patients hospitalized with complications of erysipelas (purpura, bullae, abscesses and necrosis), admitted to the University Hospital of Heraklion between 1994 and 2002, were retrospectively studied. Clinical and laboratory data were compared with those from patients with erysipelas without local complications. RESULTS In total, 145 patients were analysed, of whom 46 had local disease complications. Using bivariate analysis, the factors significantly associated with disease complications were found to be age ≥ 51 years, obesity, longer duration of local symptoms, and fever on admission. During hospitalization, increased C-reactive protein level, isolation of pathogens, longer duration of fever and/or presence of leucocytosis, absence of response to initial antibiotic therapy, and longer length of hospitalization were also associated with complications in the bivariate analysis. However, in the multivariate analysis, obesity (OR 4.489, 95% CI 1.719-11.725, P = 0.002) was the only independent factor associated with complicated erysipelas. CONCLUSIONS This study found obesity to be an independent risk factor for local complications, of erysipelas. Hence, obese patients with erysipelas are prone to complications, and should be carefully evaluated because of the potential severity of disease and the increased risk of failure of empirical antimicrobial therapy.
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Affiliation(s)
- K Krasagakis
- Department of Dermatology, University Hospital of Heraklion, Heraklion, Greece.
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8
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[Erysipelas today]. ACTA ACUST UNITED AC 2007; 60:282-6. [PMID: 17988064 DOI: 10.2298/mpns0706282g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Erysipelas is a form of cellulitis and a bacterial infection affecting the most superficial layers of the skin which is caused by group A--hemolytic Streptococcus. The symptoms of erysipelas usually arise quite suddenly and they are often accompanied by fever, chill and shivering. The affected skin is distinguished from other forms of cellulitis by well-defined, raised edge. The affected skin is red, swollen and may be finely dimpled (like an orange skin). TREATMENT OF ERYSIPELAS: Uncomplicated erysipelas can be treated on an outpatient basis. Indications for hospitalization include a severe clinical picture and socioeconomics factors. Most patients suffering from erysipelas in Belgrade are treated at the Institute of Infectious and Tropical Diseases, and the aim of this study was to analyze patients treated during 2002 and 2003, in order to determine characteristics of erysipelas at the beginning of the XXI century. MATERIAL AND METHODS During the studied period, we treated 60 patients (26.7%) of all registrated erysipelas cases in Belgrade. The male/female ratio was 1:1.6. DISCUSSION AND CONCLUSION Prevalence was higher during the summer months. In most cases, the severity and the need for hospitalization were recognized at the beginning; therefore, 74% of patients were hospitalized during the first five days from the onset of nonspecific signs of illness. Laboratory tests showed mild leukocytosis (med 12.05 x 10/9/l), with predominant neutrophils (74.8%) and increased fibrinogen (med 5.4 g/l). Predisposing factors were present in 83.3% of cases; of them, in 35% of cases this was not the first episode of this illness. In 85% of cases erysipelas of the leg was established, and it was the most frequent localization of all.
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Aragüés M, González-Arriba A. [Primary cutaneous infections due to Staphylococcus and Streptococcus]. ACTAS DERMO-SIFILIOGRAFICAS 2007; 98 Suppl 1:4-14. [PMID: 18093494 DOI: 10.1016/s0001-7310(07)70176-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Pyodermitis constitutes a very important chapter in dermatological practice. Its pathogenesis, in special the one caused by S. aureus, has improved due to the knowledge of the role developed by the host defensins, quorum-sensing signaling and the Panton-Valentine leucocidin gene among others. As well, exfoliative toxins and enterotoxins responsible for the staphylococal scalded skin syndrome (SSSS) and toxic shock syndrome, respectively, have been cloned. Also, it has been seen that bullous impetigo, SSSS and pemphigus foliaceus share a common target: desmoglein-1. The Panton-Valentine leucocidin gene has been related to the appearance of abscesses, necrotic cutaneous lesions and furuncles in young persons caused by meticillin resistant S. aureus, with its epidemiological implications. Finally, some atypical forms of erysipelas suppose a diagnostic challenge for the dermatologist.
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Affiliation(s)
- M Aragüés
- Servicio de Dermatología, Hospital Universitario de La Princesa, Madrid, España.
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Bernard P, Chosidow O, Vaillant L. Oral pristinamycin versus standard penicillin regimen to treat erysipelas in adults: randomised, non-inferiority, open trial. BMJ 2002; 325:864. [PMID: 12386036 PMCID: PMC129632 DOI: 10.1136/bmj.325.7369.864] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2002] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess the efficacy and safety of oral pristinamycin versus intravenous then oral penicillin to treat erysipelas in patients in hospital. DESIGN Multicentre, parallel group, open labelled, randomised non-inferiority trial. SETTING 22 French hospitals. PARTICIPANTS 289 adults admitted to hospital with erysipelas. RESULTS At follow up (day 25-45) the cure rate (primary efficacy end point) for the per protocol populations was 81% (83/102) for pristinamycin and 67% (68/102) for penicillin. The planned interim analysis (global one sided type I error 5%) showed that the one sided 97.06% confidence interval of the observed difference (pristinamycin-penicillin) between cure rates (3.3% to infinity ) exceeded the -10% non-inferiority threshold. For the intention to treat populations the cure rate at follow up was 65% (90/138) for pristinamycin and 53% (79/150) for penicillin, with the one sided 97.06% confidence interval of the observed difference between cure rates (1.7% to infinity ) exceeding the -10% non-inferiority threshold. That the lower limit of the confidence interval exceeded the -10% threshold and was also >0 supports the hypothesis that pristinamycin is significantly superior at the 5% level. More adverse events related to treatment, as assessed by the investigators, were reported in the pristinamycin group than in the penicillin group. Most adverse events involved the gastrointestinal tract (nausea, vomiting, and diarrhoea) but were minor and usually did not require discontinuation of treatment. CONCLUSION Pristinamycin could be an alternative to the standard intravenous then oral penicillin regimen used to treat erysipelas in adults in hospital, with the advantages of oral first line therapy.
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Affiliation(s)
- Philippe Bernard
- Department of Dermatology, Hôpital Robert-Debré, 51092 Reims, France.
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Bernardes CHDA, Augusto JCDA, Lopes LTC, Cardoso KT, Santos JRD, Santos LMD. Experiência clínica na avaliação de 284 casos de erisipela. An Bras Dermatol 2002. [DOI: 10.1590/s0365-05962002000500011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Os autores analisam algumas características da erisipela no Brasil, alertando para a importância das formas de prevenção de recorrências, que podem ocasionar um quadro clínico de elefantíase, limitando muito as atividades familiares, sociais e profissionais do paciente. Fazem uma análise retrospectiva de 284 casos de erisipela no período de 1995 a 1996, analisando os seguintes fatores: sexo, idade, topografia da lesão, predisposição local e sistêmica, porta de entrada, tratamento, complicações e eventual necessidade de internação. Os resultados mostram que os homens e os obesos são mais atingidos pela doença, a faixa etária com maior incidência é a dos 60 aos 70 anos, e os membros inferiores são os locais de preferência para instalação. Nesta casuística, a tinha dos pés foi a principal porta de entrada da infecção bacteriana, e, quando o paciente apresentava bolhas necrotizantes, houve necessidade de internação hospitalar para tratamento. Como medicação de escolha e não havendo contra-indicação, a maioria dos casos foi tratada com penicilina benzatina e a cristalina.
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Simonart T, Simonart JM, Derdelinckx I, De Dobbeleer G, Verleysen A, Verraes S, de Maubeuge J, Van Vooren JP, Naeyaert JM, de la Brassine M, Peetermans WE, Heenen M. Value of standard laboratory tests for the early recognition of group A beta-hemolytic streptococcal necrotizing fasciitis. Clin Infect Dis 2001; 32:E9-12. [PMID: 11202110 DOI: 10.1086/317525] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The laboratory data for 17 patients with group A beta-hemolytic streptococcal necrotizing fasciitis (GAS NF) were compared with data for 145 patients hospitalized for cellulitis during the same period. Admission values of C-reactive protein and creatine kinase were higher for patients in the group with GAS NF than for patients in the group with cellulitis (P<.001), suggesting that standard laboratory tests may be useful for the early differential diagnosis of GAS NF and cellulitis.
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Dupuy A, Benchikhi H, Roujeau JC, Bernard P, Vaillant L, Chosidow O, Sassolas B, Guillaume JC, Grob JJ, Bastuji-Garin S. Risk factors for erysipelas of the leg (cellulitis): case-control study. BMJ (CLINICAL RESEARCH ED.) 1999; 318:1591-4. [PMID: 10364117 PMCID: PMC28138 DOI: 10.1136/bmj.318.7198.1591] [Citation(s) in RCA: 368] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess risk factors for erysipelas of the leg (cellulitis). DESIGN Case-control study. SETTING 7 hospital centres in France. SUBJECTS 167 patients admitted to hospital for erysipelas of the leg and 294 controls. RESULTS In multivariate analysis, a disruption of the cutaneous barrier (leg ulcer, wound, fissurated toe-web intertrigo, pressure ulcer, or leg dermatosis) (odds ratio 23.8, 95% confidence interval 10.7 to 52.5), lymphoedema (71.2, 5.6 to 908), venous insufficiency (2.9, 1.0 to 8.7), leg oedema (2.5, 1.2 to 5.1) and being overweight (2.0, 1.1 to 3.7) were independently associated with erysipelas of the leg. No association was observed with diabetes, alcohol, or smoking. Population attributable risk for toe-web intertrigo was 61%. CONCLUSION This first case-control study highlights the major role of local risk factors (mainly lymphoedema and site of entry) in erysipelas of the leg. From a public health perspective, detecting and treating toe-web intertrigo should be evaluated in the secondary prevention of erysipelas of the leg.
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Affiliation(s)
- A Dupuy
- Dermatology Department, Hôpital Henri Mondor, 94010 Créteil, France
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