Erysipelas - Causes, Symptoms and Treatment

Erysipelas is an acute streptococcus bacterial infection of the dermis. Erysipelas is characterized by intense erythema, induration, and a sharply demarcated border, which differentiates it from other skin infections. This disease has been traced back to the Middle Ages where it was referred to as "St Anthony's Fire," Erysipelas is somewhat more common in European countries. Erysipelas is a skin infection that often follows strep throat. Infection involves the dermis and lymphatics and is a more superficial subcutaneous infection of the skin than cellulitis. Isolated cases are still the rule, and distribution and etiology remain similar to that in the United States. Bacterial inoculation into an area of skin trauma is the initial event in developing erysipelas. Local factors, such as venous insufficiency, stasis ulcerations, inflammatory dermatoses, dermatophyte infections, insect bites, and surgical incisions, have been implicated as portals of entry. The source of the bacteria in facial erysipelas is often the host's nasopharynx, and a history of recent streptococcal pharyngitis has been reported in up to one third of cases. Other predisposing factors include diabetes, alcohol abuse, HIV infection, nephrotic syndrome, other immunocompromising conditions, and vagrant lifestyle. The most common complaints during the acute infection include tenderness of the involved area, fever, chills, and swelling. Death as a direct result of erysipelas is exceedingly rare. Predisposed patients often develop local recurrence, and this can lead to disfiguring and disabling healing reactions, such as elephantiasis nostras verrucosa. This chronic warty, edematous condition is caused by lymphatic destruction from repeated infection.

Erysipelas generally is benign; however, it can be fatal when associated with bacteremia in very young, elderly, or immunocompromised patients. Some cases of erysipelas have an inciting wound such as trauma, an abrasion, or some other break in the skin that precede the fiery infection. However, in most cases, no break in the skin can be found. Erysipelas starts suddenly. High temperature, shiver and feel unwell a few hours before any changes appear on your skin. The affected patch of skin will then become red, sore and swollen, and start to spread. Erysipelas is a febrile illness with dermatological findings, characterized by an abrupt onset of illness with initial fever and chills followed by a painful rash occurring 1-2 days later. Local signs of inflammation, such as warmth, edema, and tenderness, are universal. Lymphatic involvement often is manifested by overlying skin streaking and regional lymphadenopathy. More severe infections may exhibit numerous vesicles and bullae along with petechiae and even frank necrosis. Erysipelas can be differentiated from cellulitis by its characteristically raised advancing edges and sharply demarcated borders, reflecting its more superficial nature. Cellulitis has no lymphatic component and exhibits indiscreet margins. Most streptococcal bacteria causing erysipelas are sensitive to penicillin antibiotics and penicillin, either orally or intravenously (if patient is very unwell), is the antibiotic of first choice. Erythromycin may be used as an alternative in patients with penicillin allergy.

Causes of Erysipelas

Common Causes and Risk factors of Erysipelas

Streptococcus pneumoniae.
Klebsiella pneumoniae.
Haemophilus influenzae.
Yersinia enterocolitica.
Moraxella species.
Trauma.
Arteriovenous insufficiency.
Paretic limbs.

Sign and Symptoms of Erysipelas

Common Sign and Symptoms of Erysipelas

High fevers.
Shaking.
Chills.
Fatigue
Headaches.
Vomiting.

Treatment for Erysipelas

Common Treatment for Erysipelas

Erysipelas is treated with antibiotics. penicillin antibiotics , either orally or intravenously (if patient is very unwell), is the antibiotic of first choice.
Erythromycin may be used as an alternative in patients with penicillin allergy. Treatment is usually for 10-14 days, and while signs of general illness resolve within a day or two, the skin changes may take some weeks to resolve completely.
Roxithromycin and pristinamycin, have been reported to be extremely effective in the treatment of erysipelas.
Predisposing lower extremity skin lesions (eg, tinea pedis, stasis ulcers) should be treated aggressively to prevent superinfection. Use of compression stockings should be encouraged for as long as 1 month in previously healthy patients and for the long-term in patients with preexisting lower extremity edema.
Long-term prophylactic antibiotic therapy generally is accepted, but no true guidelines are available.

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