From the Guidelines
The treatment for facial erysipelas secondary to poison ivy contact dermatitis involves a combination of antibiotics and management of the underlying allergic reaction, with oral antibiotics such as cephalexin 500mg four times daily for 7-10 days or clindamycin 300mg four times daily if penicillin-allergic, as recommended by the 2018 WSES/SIS-E consensus conference 1. For the bacterial infection (erysipelas), antibiotics effective against Streptococcus and Staphylococcus are necessary.
- Cephalexin 500mg four times daily for 7-10 days is a suitable option.
- Clindamycin 300mg four times daily is an alternative for patients who are penicillin-allergic. Simultaneously, the poison ivy dermatitis should be treated with:
- Topical corticosteroids like triamcinolone 0.1% cream applied twice daily to affected areas.
- For severe cases, a short course of oral prednisone may be necessary, starting at 40-60mg daily and tapering over 2-3 weeks, as suggested by general medical practice. Additional measures include:
- Cool compresses with aluminum acetate solution to provide symptomatic relief.
- Keeping the area clean and avoiding scratching to prevent secondary infection.
- Seeking immediate medical attention if fever persists, facial swelling worsens, or if there's eye involvement, as emphasized by the practice guidelines for the diagnosis and management of skin and soft tissue infections 1. This dual approach is necessary because erysipelas is a bacterial infection requiring antibiotics, while the underlying poison ivy reaction is an allergic contact dermatitis that responds to anti-inflammatory treatments.
From the FDA Drug Label
Infections of the Skin and Skin Structure Amoxicillin is indicated in the treatment of infections due to susceptible (ONLY β-lactamase–negative) isolates of Streptococcus spp. (α- and β-hemolytic isolates only), Staphylococcus spp., or E. coli.
The treatment for facial erysipelas (facial skin infection) secondary to poison ivy contact dermatitis may include amoxicillin. The recommended dosage for adult patients with mild to moderate skin and skin structure infections is 500 mg every 12 hours or 250 mg every 8 hours 2. For severe infections, the recommended dosage is 875 mg every 12 hours or 500 mg every 8 hours.
- Treatment should be continued for a minimum of 48 to 72 hours beyond the time that the patient becomes asymptomatic or evidence of bacterial eradication has been obtained.
- It is recommended that there be at least 10 days’ treatment for any infection caused by Streptococcus pyogenes to prevent the occurrence of acute rheumatic fever.
From the Research
Treatment for Facial Erysipelas Secondary to Poison Ivy
The treatment for facial erysipelas, a skin infection that can occur secondary to poison ivy contact dermatitis, involves addressing the bacterial infection. Key points to consider include:
- The causative agent of erysipelas is typically group A streptococci 3, 4, 5, 6.
- Penicillin remains the gold standard treatment for erysipelas 3, 4, 5, 6.
- Other antibiotics, such as amoxicillin and macrolides, may also be effective 3.
- Treatment should also consider the portal of entry, which in this case is poison ivy contact dermatitis.
- The microbiology of infected poison ivy dermatitis can involve a variety of bacteria, including Staphylococcus aureus and group A beta-haemolytic streptococci 7.
Management Considerations
Management of facial erysipelas secondary to poison ivy may involve:
- Antibiotic therapy with penicillin or other effective antibiotics 3, 4, 5, 6.
- Treatment of the underlying poison ivy contact dermatitis.
- Monitoring for potential complications, such as recurrence or spread of the infection.
- Consideration of the patient's overall health and potential risk factors for complications 3, 4.
Specific Treatment Options
Specific treatment options for facial erysipelas secondary to poison ivy may include: