Erysipelas

Acute infection of the upper dermis and superficial lymphatics

Erysipelas is an acute bacterial infection of the upper dermis and superficial lymphatics, typically caused by Streptococcus pyogenes, also known as group A streptococcus. It is characterized by a well-defined, raised, red area of skin that is often warm to the touch and painful.

Signs and symptoms

Erysipelas presents with a sudden onset of symptoms, including:

• Affected skin that appears red, swollen, and warm
• A well-demarcated, raised edge of the affected area
• Pain and tenderness in the affected area
• Fever and chills
• Swollen and tender lymph nodes

The infection most commonly affects the face and legs, but it can occur on any part of the body.

Causes

Erysipelas is primarily caused by Streptococcus pyogenes, a bacterium that is part of the group A streptococci. The bacteria enter the skin through minor cuts, abrasions, or other breaks in the skin barrier. Risk factors for developing erysipelas include:

• Lymphedema
• Venous insufficiency
• Diabetes mellitus
• Alcoholism
• Immunocompromised states

Diagnosis

Diagnosis of erysipelas is primarily clinical, based on the characteristic appearance of the skin and the rapid onset of symptoms. Laboratory tests are not usually necessary, but a complete blood count may show elevated white blood cells, indicating infection. In some cases, a blood culture may be performed to identify the causative organism.

Treatment

The mainstay of treatment for erysipelas is antibiotic therapy. Penicillin is the antibiotic of choice, given its effectiveness against Streptococcus pyogenes. For patients allergic to penicillin, alternatives such as erythromycin or clindamycin may be used. In addition to antibiotics, supportive care includes:

• Rest and elevation of the affected limb
• Analgesics for pain relief
• Hydration

Complications

If left untreated, erysipelas can lead to complications such as:

• Abscess formation
• Cellulitis
• Sepsis
• Thrombophlebitis

Prevention

Preventive measures for erysipelas include:

• Maintaining good skin hygiene
• Prompt treatment of skin injuries
• Managing underlying conditions such as diabetes and venous insufficiency

Related pages

• Cellulitis
• Streptococcus pyogenes
• Lymphangitis