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2. The patient had a painful, erythematous skin rash over the bridge of her nose, spreading to the malar area, eyelids, and forehead.

Diagnosis: Erysipelas is an acute superficial cellulitis with lymphatic involvement. It is characterized by the abrupt onset of a warm, erythematous rash with a sharply demarcated, indurated, elevated margin. There are no suppurative foci; sometimes, however, there are bullae or vesicles.

In facial “butterfly” erysipelas (which this patient had), the plaques may involve the eyelids, cheeks, nose, and forehead. Upon palpation, the skin is hot and tender. As the process develops, the color becomes a dark, fiery red and vesicles appear at the advancing border and over the surface. Associated regional lymphadenopathy may be present. There is no necrosis.1

Read more about erysipelas at Painful rash on face. J Fam Pract. 2010 August;59(8):459-462.

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