We appreciate the historical perspective suggested by Leicht; however, we disagree with the conclusions. The studies cited from the early part of this century used "crude sterilized extract of streptococci" to reproduce recurrent erysipelas; this extract very well may have contained streptococcal toxins that led to the clinical effect, as opposed to representing a bacterial "allergy." Certainly, at the time, the current technology to assay for toxins did not exist.
The recurrent localization of cellulitis to a lower extremity is not infrequently encountered in clinical practice, and is likely due to local factors such as lymphedema and portals of entry such as tinea pedis, as suggested by Leicht. However, there was no evidence in our young, otherwise healthy patients of local predisposing conditions; the concurrent pharyngeal bacterial infection during episodes only supports a toxin-mediated event.
The suggestion that there is "no logical reason" that a systemic agent should "focally and
Manders SM, Heymann WR. Multiply Recurrent Cellulitis-Reply. Arch Dermatol. 1996;132(9):1132. doi:10.1001/archderm.1996.03890330148033