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April 1979

Necrotizing Fasciitis

Author Affiliations

Grand Forks, ND

Arch Dermatol. 1979;115(4):507. doi:10.1001/archderm.1979.04010040079026

To the Editor.—  I read with interest the article on "Necrotizing Fasciitis" (Archives 114:581-583, 1978) by Gerard G. Koehn, MD. I cannot, however, agree with the statement that "erysipelas, as opposed to necrotizing fasciitis, lacks bullae and central necrosis." It has long been recognized, and it is so recorded in practically every standard text of dermatology, that severe forms of erysipelas do become bullous and central necrosis may develop. This is so stated in the classical textbook by Ormsby and Montgomery1 and the most recent editions of Dermatology by Moschella and coauthors,2 or the encyclopedic work of Demis et al.3 In the Spanish textbook by Professor Jose G. Prieto4 several clinical forms are described, including a gangrenous erysipelas and a bullous form.It seems important to me to call this to the readers' attention since this is the main point of clinical differentiation, as proposed by Dr

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