Infectious skin diseases constitute a significant public health problem. Despite the systematic development of many modern diagnostic and therapeutic tools, they still pose a serious challenge for clinicians. Due to their prevalence and mild course in most cases, they are often marginalized, which can delay their diagnosis and treatment initiation. Such an approach in more clinically advanced cases can have serious consequences, sometimes leading to tragic outcomes. This work presents a series of four cases of common infectious skin diseases with an unusually atypical clinical picture: the history of a 49-year-old female patient with recurrent erysipelas of the right lower leg co-occurring with a SARS-CoV-2 infection, a 75-year-old male patient with a generalized form of herpes zoster, a 38-year-old female patient with a complicated severe course of head lice, and a 34-year-old male patient with a severe form of post-steroid mycosis. In each of these cases, difficulties in making the correct diagnosis were highlighted, even though they represent some of the most common bacterial, viral, parasitic, and fungal dermatoses. The paper discusses the risk factors for these diseases, the pathophysiology of their atypical course, the effects and challenges in the therapeutic approach conducted. Infectious skin dermatoses require aggressive treatment and should never be underestimated.
Choroby zakaźne skóry są istotnym problemem zdrowia publicznego. Pomimo systematycznego rozwoju nowoczesnych narzędzi diagnostycznych oraz terapeutycznych stanowią poważne wyzwanie dla klinicystów. Ze względu na swoją powszechność niejednokrotnie są marginalizowane, co może opóźniać diagnozę oraz wdrożenie leczenia. Takie postępowanie w bardziej zaawansowanych klinicznie przypadkach może mieć poważne, czasem tragiczne następstwa. W pracy prezentowana jest seria czterech przypadków częstych chorób zakaźnych skóry o wyjątkowo nietypowym obrazie klinicznym: 49-letniej pacjentki z różą nawrotową podudzia prawego współwystępującej z infekcją SARS-CoV-2, 75-letniego pacjenta z uogólnioną, ciężką formą półpaśca, 38-letniej pacjentki z wszawicą głowową oraz 34-letniego pacjenta z ciężką postacią grzybicy skóry głowy owłosionej (typu „incognito”). W każdym z wymienionych przypadków zaprezentowano problemy z ustaleniem prawidłowej diagnozy, pomimo, że reprezentują one powszechnie występujące dermatozy bakteryjne, wirusowe, pasożytnicze oraz grzybicze. W pracy zostały omówione czynniki ryzyka ww. chorób, patofizjologia ich nietypowego przebiegu, efekty oraz wyzwania w przeprowadzonym postępowaniu terapeutycznym. Dermatozy zakaźne skóry wymagają intensywnego leczenia i nie powinny być nigdy bagatelizowane.

Bacterial skin infections represent a significant health care burden. Cellulitis and erysipelas are rapidly spreading, painful, superficial skin infections, usually caused by streptococci or Staphylococcus aureus. Folliculitis is an infection of hair follicles mostly caused by S aureus. Simple folliculitis typically is self-limited. Topical benzoyl peroxide is a first-line nonantibiotic treatment. Mupirocin and clindamycin are topical antibiotic options. For treatment-resistant cases, oral cephalexin or dicloxacillin is an appropriate option. Impetigo is a common, self-limited infection in children. Bullous impetigo is caused by S aureus, and nonbullous impetigo is caused by beta-hemolytic streptococci, S aureus, or both. In most cases, topical mupirocin or retapamulin (Altabax) is effective. Oral antibiotics should be considered for household outbreaks or patients with multiple lesions. Abscesses are red, painful collections of purulence in the dermis and deeper tissues caused by S aureus or polymicrobial infections. Furuncles are abscesses of a hair follicle, whereas carbuncles involve several hair follicles. In recurrent cases of these lesions, culture of the exudate is recommended. Abscess, furuncle, and carbuncle management consists of incision and drainage. Oral antibiotics are not necessary in most cases but should be prescribed for patients with severe immunocompromise or systemic signs of infection. In bacterial skin infections, methicillin-resistant S aureus coverage should be considered for patients with infections that have not improved with treatment.

The benefit of lower limb compression therapy is not limited to chronic venous insufficiency or/and lymphoedema. Thanks to its anti-edema and anti-inflammatory effects, compression therapy is considered a beneficial adjuvant therapy to treat atypical wounds, inflammatory dermatoses, cellulitis, and traumatic wounds in the absence of contraindications. Strict contraindications are limited to severe peripheral arterial disease and decompensated heart failure. The variability of commercially available compression materials and systems, such as short-stretch bandages, multi-component systems, zinc oxide bandages, medical adaptive compression systems, ulcer compression stockings or medical compression stockings, facilitates the adaptation of compression therapy to the individual needs of each patient. Compared to venous leg ulcers, low pressures of 20mmHg are often sufficient to treat dermatological disorders, with higher patient tolerance and compliance.

UNASSIGNED: Previous studies have suggested a link between gut microbiota and skin diseases, including erysipelas, an inflammatory skin condition. Despite this, the precise nature of the relationship between erysipelas and gut microbiota remains unclear and subject to debate.
UNASSIGNED: We conducted a Mendelian Randomization (MR) analysis using publicly available summary data from genome-wide association studies (GWAS) to explore the potential causal relationship between gut microbiota and erysipelas. Instrumental variables (IVs) were identified using a comprehensive set of screening methods. We then performed MR analyses primarily using the Inverse Variance Weighted (IVW) method, complemented by alternative approaches such as MR Egger, weighted median, simple mode, and weighted mode. A series of sensitivity analyses, including Cochran\'s Q test, MR-Egger intercept test, Mendelian Randomization Pleiotropy RESidual Sum and Outlier (MR-PRESSO) test, and a leave-one-out test, were executed to ensure the robustness and validity of our findings.
UNASSIGNED: We identified potential associations between erysipelas and various gut microbiota, including Alcaligenaceae (OR 1.23; 95% CI 1.06-1.43; p=0.006), Rikenellaceae (OR 0.77; 95% CI 0.67-0.90; p=0.001), and others. Notably, associations with Actinomyces, Lachnospiraceae NC2004 group, Ruminiclostridium 9, Ruminococcaceae UCG014, Odoribacter, and Actinobacteria were also observed. Sensitivity analyses confirmed the robustness of these associations.
UNASSIGNED: Our MR analysis suggests both potentially beneficial and harmful causal relationships between various gut microbiota and the incidence of erysipelas. This study provides new theoretical and empirical insights into the pathogenesis of erysipelas and underscores the potential for innovative preventive and therapeutic approaches.

BACKGROUND: New skin and soft tissue infections (SSTI) guidelines were published in 2019 in France, changing the recommended duration for antibiotic treatment. The objective of the present study was to assess the impact of the publication of the 2019 French guidelines on SSTIs on the duration of antibiotic prescription for erysipelas.
METHODS: In a before-after study (a year before and a year after April 1st, 2019), we included all adult patients diagnosed with erysipelas in Reims University Hospital medical wards and the emergency department. We retrospectively retrieved antibiotic prescription duration in the patients\' medical files.
RESULTS: Among 50 patients in the \"before\" and 39 in the \"after\" group, the mean duration of antibiotic prescription was significantly shorter in the \"after\" group (9.4 ± 2.8 vs. 12.4 ± 3.8 days, p = 0.0001).
CONCLUSIONS: A 25% decrease in the duration of antibiotic prescription for erysipelas was observed following the implementation of these guidelines, providing useful information for an antibiotic stewardship policy.

Erysipelas/cellulitis are severe skin infections that are especially dangerous for immunocompromised patients. The most common cause of these diseases is streptococcal infection, but sometimes they may be caused by other Gram-positive or negative bacteria or other factors. Proper diagnosis and treatment should be implemented accurately to prevent dangerous complications. We present a case of severe bullous erysipelas caused by Escherichia coli and discuss the diagnosis, differential diagnosis, and treatment of cellulitis in kidney transplant patients.

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The benefit of lower limb compression therapy is not limited to chronic venous insufficiency or/and lymphoedema. Thanks to its anti-edema and anti-inflammatory effects, compression therapy is considered a beneficial adjuvant therapy to treat atypical wounds, inflammatory dermatoses, cellulitis, and traumatic wounds in the absence of contraindications. Strict contraindications are limited to severe peripheral arterial disease and decompensated heart failure. The variability of commercially available compression materials and systems, such as short-stretch bandages, multi-component systems, zinc oxide bandages, medical adaptive compression systems, ulcer compression stockings or medical compression stockings, facilitates the adaptation of compression therapy to the individual needs of each patient. Compared to venous leg ulcers, low pressures of 20mmHg are often sufficient to treat dermatological disorders, with higher patient tolerance and compliance.

Infections by Erysipelothrix rhusiopathiae occur in domestic animals and cause the disease known as \'erysipelas\'. The ubiquity of Erysipelothrix spp. makes infection possible in a wide range of vertebrates and invertebrates. Cetaceans are highly susceptible to erysipelas, especially those under human care. The number of cases documented in wild cetaceans is low, the pathogenesis is incompletely understood, and the full spectrum of lesions is not well defined. The possible serotypes and species of the genus that can cause disease are unknown. In October 2022, a common bottlenose dolphin Tursiops truncatus stranded in Vilassar de Mar (Catalonia) showing skin lesions consistent with \'diamond skin disease\', a characteristic lesion of erysipelas shared by swine and cetaceans. Necropsy was performed following standardized procedures, and multiple samples were taken for histopathology and bacteriology. Erysipelothrix sp. grew in pure culture in many tissue samples. Genetic characterization by multi-locus sequence analysis identified the species as E. rhusiopathiae. Histologically, the main lesions were an intense suppurative vasculitis of leptomeningeal arteries and veins with abundant intramural Gram-positive bacilli and meningeal hemorrhages. Meningeal lesions were considered the cause of death. The affected skin showed moderate suppurative dermatitis. Herein we document a case of erysipelas in a Mediterranean common bottlenose dolphin with unusual lesions in the leptomeningeal vessels and marked skin tropism. To our knowledge, this is the first case of severe brain involvement in erysipelas in a cetacean. We also provide a review of available cases in wild cetaceans, to highlight the characteristics of the disease and improve future diagnosis.

In addition to venous and lymphatic diseases, there is increasing scientific evidence that inflammatory dermatoses of the legs are also indications for compression therapy. Specifically, diseases such as pyoderma gangrenosum, livedoid vasculopathy, cutaneous vasculitides, necrobiosis lipoidica, psoriasis, or erysipelas are conditions for which adjunctive compression therapy may be used when manifestations occur on the lower extremities. When inflammatory dermatoses are accompanied by edema, compression therapy is not an off-label use. Especially because of the often problematic pain symptoms, compression therapy can be performed with low resting pressures around 20 mmHg, especially in inflammatory dermatoses.In this review article, the current scientific aspects of compression therapy in inflammatory dermatoses of the legs and the corresponding limitations are presented in a differentiated manner.
Es gibt zunehmend wissenschaftlich belegte Hinweise darauf, dass entzündliche Dermatosen der Beine neben venösen und lymphatischen Krankheitsbildern Indikationen für Kompressionstherapie sind. Konkret sind es Erkrankungen, wie Pyoderma gangraenosum, Livedovaskulopathie, kutane Vaskulitiden, Necrobiosis lipoidica, Psoriasis oder Erysipel, bei denen eine begleitende Kompressionstherapie bei einer Manifestation an den unteren Extremitäten durchgeführt werden kann. Wenn entzündliche Dermatosen mit einem Ödem einhergehen, handelt es sich bei der Kompressionstherapie nicht um einen Off-Label-Use. Insbesondere aufgrund der oft problematischen Schmerzsymptomatik kann gerade bei entzündlichen Dermatosen die Kompressionstherapie mit niedrigen Ruhedruckwerten um 20 mmHg durchgeführt werden.In diesem Übersichtsbeitrag werden die aktuellen wissenschaftlichen Aspekte der Kompressionstherapie bei entzündlichen Dermatosen der Beine und die entsprechenden Limitationen differenziert dargestellt.