Erysipelas: Description, Causes and Risk Factors:A specific, acute, superficial cutaneous cellulitis caused by ß-hemolytic streptococci and characterized by hot, red, edematous, brawny, and sharply defined eruptions; usually accompanied by severe constitutional symptoms.Erysipelas is a non-necrotizing bacterial hypodermal cellulitis usually associated with streptococcal infection. It may be a mainly secondary complication of chronic lymphedema, and occurs in 20% to 30% of cases. The first presenting signs are sudden fever and shivering. The clinical feature is inflammatory plaque, which is often chronic and accompanied by fever. Inflammatory plaque is promoted by lymph stasis, and is marked by inflammatory episodes that often regress spontaneously.Isolated cases are the rule with erysipelas, although epidemics have been reported. The incidence of erysipelas declined throughout the mid-20th century, possibly due to antibiotic development, improved sanitation, and decreased virulence. The change in distribution from the face to the lower extremities is most likely related to an aging population with risk factors such as lymphedema. Approximately 85% of cases of erysipelas occur on the legs rather than the face.Erysipelas is somewhat more common in European countries. Isolated cases are still the rule, and distribution and etiology remain similar to that in the United States. Cases of erysipelas have been reported in all age groups, but it does appear that infants, young children, and elderly patients are the most commonly affected groups.Erysipelas per se is mainly treated with antibiotics. The prevention of recurrence is primary. Since lymphedema is the first risk factor for recurrence, its treatment and risk of occurrence must be considered. This includes physiotherapy, well-adapted compression therapy, and avoidance of wounds.Symptoms:Symptoms may include:Blisters.
Painful, very red, swollen, and warm skin underneath the sore (lesion).
Skin lesion with a raised border.
Sores (erysipelas lesions) on the cheeks and bridge of the nose.
Diagnosis:Erysipelas is diagnosed mainly by the appearance of the rash. Blood tests and skin biopsies generally do not help make the diagnosis. In the past, saline solution was injected into the edge of the rash, aspirated back out, and cultured for bacteria. This method of diagnosis is not used anymore because bacteria were not found in the majority of cases. If the preceding symptoms such as fever and fatigue are significant enough, sometimes blood is drawn and cultured for bacteria to rule out sepsis.MRI and bone scintigraphy are helpful when early osteoarticular involvement is suspected. In this setting, standard radiographic findings typically are normal.Treatment:Erysipelas is treated with antibiotics. A variety of antibiotics can be used including penicillin, dicloxacillin, cephalosporins, clindamycin, and erythromycin. Most cases of erysipelas can be treated with oral antibiotics. However, cases of sepsis, or infections that do not improve with oral antibiotics require IV antibiotics administered in the hospital.Patients with recurrent erysipelas should be educated regarding local antisepsis and general wound care. Predisposing lower extremity skin lesions (e.g., tinea pedis, toe web intertrigo, stasis ulcers, asteatotic dermatitis) 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 long term in patients with lower extremity edema.NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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