BACKGROUND: Erysipelas is a common infectious skin disease. A typical feature of erysipelas, especially on the lower limbs, is the tendency to reoccur and the study aimed to define the comorbidities associated with it. AIM: We aimed to investigate systemic and local comorbidities in patients diagnosed with erysipelas on the lower limbs. MATERIAL AND METHODS: We conducted a retrospectively-prospective, population-based cohort study which included all patients diagnosed with erysipelas on the lower limbs, during two years. Patients were divided into two groups: patients with first episode and patients with recurrent erysipelas. These two groups were compared, with particular emphasis on systemic and local comorbidities. RESULTS: The study included 313 patients, of which 187 with the first episode of erysipelas and 126 with a recurrent. Regarding the analyzed systemic risk factors, the recurrent erysipelas was significantly associated with obesity (p < 0.0001), insulin dependent diabetes mellitus (p = 0.0015), history of malignant disease (p = 0.02) and tonsillectomy (p = 0.000001). For a p-value < 0.0001, significantly more frequent finding of peripheral arterial occlusive disease, chronic oedema/lymphoedema, fungal infections of the affected leg and chronic ulcer was confirmed in recurrent erysipelas. Neuropathy had 23% of the recurrent cases and 8.6% in patients without recurrence, and the difference was found to be significant for p = 0.0003. The only dissection of the lymph nodes was found more frequently in recurrent erysipelas (p = 0.017), but no associations with other analysed local surgery on the affected leg. Patients with recurrent erysipelas had ipsilateral coexisting dermatitis p = 0.00003 significantly more frequent. Minor trauma often preceded the first episode of erysipelas p = 0.005. CONCLUSION: Identification and treatment of modifiable risk factors are expected to reduce the risk of a subsequent episode of erysipelas on the lower limbs

AIM: Typical feature of erysipelas, especially on the lower limbs, is the tendency to reoccur. The study aimed to identify clinical and laboratory characteristics of acute and recurrent erysipelas. MATERIAL AND METHODS: We prospectively included patients diagnosed with erysipelas on the lower limbs in the period from January 2016 to December 2017. Patients were divided into two groups: patients with the first episode and recurrent erysipelas. The groups were compared by their demographics, clinical and laboratory characteristics. RESULTS: The study included 187 patients with the first episode of erysipelas and 126 patients with recurrent erysipelas. Both groups were homogeneous in terms of demographic characteristics, gender and age. Mean age of patients with the first episode of erysipelas was 64.18 ± 12.5 years; patients with recurrent erysipelas were inconsiderably mean younger (62.98 ± 12.5 years). Patients in both groups had a significantly different anatomical localisation of skin infection (p = 0.008). Tibial localisation was more frequent in patients with the first episode of erysipelas 77% vs 62.7%, while recurrent erysipelas was more frequent on the foot 36.5% vs 23%. No significant difference was found, about the affected side of the limb (p = 0.95). Patients with recurrent erysipelas had a pronounced inflammatory response, seen through significantly higher values of C reactive protein (p = 0.02), granulocytes (p = 0.03), fibrinogen (p < 0.0001), and higher body temperature, (37.22 ± 0.97 p = 0.006). Length of hospital stay was increased in the recurrent group. CONCLUSION: Erysipelas is more frequent in older people; it has seasonal character and tendency to reoccur. Identifying clinical and laboratories characteristics of those at risk may prevent recurrence and long term comorbidities.

BACKGROUND: Cellulitis is a common infectious disease with typical feature – the tendency for recurrence. AIM: The aim of the study was to define comorbidities, clinical, and laboratory – biochemical factors associated with longer length of stay (LOS) in patients with recurrent cellulitis in the lower legs. MATERIALS AND METHODS: The study is a retrospective-cohort study conducted at the Department of Dermatovenerology at General Hospital in Skopje, from January 2016 to August 2019. In the study, we included and analyzed only hospitalized patients admitted for recurrent cellulitis on the lower legs. Inclusion in the study recorded the following variables – comorbid conditions in the patients – present in the medical records or obtained from the interview of the patient and initial values of laboratory assays on admission. RESULTS: The study included hospitalized 205 patients, admitted for recurrent cellulitis. The most significant comorbid conditions and laboratory parameters which correlate with increased LOS are as follows: Type 2 diabetes mellitus – insulin dependent (p < 0.001), chronic renal failure (p = 0.003), ischemic heart disease (p = 0.006), peripheral arterial disease (p = 0.007), fever ≥38.0°C (p < 0.001), hypoalbuminemia ˂34 g/L (p < 0.001), elevated value of C-reactive protein >10 mg/L (p < 0.001), and leukocytosis >109 L (p = 0.009). CONCLUSION: Cellulitis is potential medical emergency event. Recurrence is the most significant complication of cellulitis and lower legs cellulitis is associated with a risk for long-term morbidity. The study has identified several independent factors that are significantly associated with an increased LOS. This independent factors present on admission can stratify the patient with the highest risk of mortality, can improve patient care for better outcomes, and decrease the number of relapses and hospital readmissions.

The novel coronavirus (CoV), CoV disease (COVID)-19, and the ongoing pandemic, is changing every aspect of the human life. Furthermore, the COVID-19 pandemic has a profound impact on health-care worldwide, with no exception in dermatology care units. At the time of pandemic, constant fear and stress are present on the surface. Skin diseases are the most common somatic causes of psychological disorders and, conversely. During a stressful situation, the body has power to adjust and to maintain its well-being, but with prolonged exposure to stress, the first negative changes such as fear, anxiety, and depression will eventually lead to chronic fatigue and an increased risk of disease. The proportion of patients reporting emotional triggers varies with the disease, ranging from approximately 50% in acne to 90% in rosacea, alopecia areata, psoriasis, neurotic excoriations, and lichen simplex and may be 100% for patients with hyperhidrosis. In this paper, we will look at the most common psychodermatological disorders and its implication in the era of COVID-19 pandemic. According to all the pathophysiological conditions that indicate the association of skin diseases with stress, it is normal to expect their deterioration and occurrence in this pandemic period. We will be witnessing a growing number in patients’ consultations with chronic urticaria, dermographism, worsening rosacea, generalization, and relapses of psoriasis. It is needed to be prepared for as many cases as possible, because the psychological consequences will still be felt. We encourage more comprehensive studies of the implications of the COVID-19 pandemic in these patients.