A streptococcal infection (see STREPTOCOCCUS) of the skin characterised by an acute onset with fever, malaise and a striking, usually unilateral, rash (see ERUPTION) almost always on a lower leg or the face. Shivering, local pain and tenderness are associated with a sharply deﬁned, spreading, bright red swollen zone of skin inﬂammation. On the leg, blistering and PURPURA may follow. The bacteria enter the skin through a ﬁssure in a toe cleft (often associated with tinea pedis [RINGWORM]) or via a crack in the skin behind an ear or in a nostril.
Treatment PENICILLIN in full dosage should be given orally for ten days. In those allergic to penicillin, ERYTHROMYCIN can be substituted. Recurrent attacks are common and may cause progressive lymphatic damage leading to chronic OEDEMA. Such recurrences can be prevented by long-term prophylactic oral penicillin.