Erysipelas: Causes, Symptoms and Treatment
Erysipelas is a bacterial skin infection causing a bright red, sharply bordered, painful rash. It is most commonly caused by group A Streptococcus bacteria.
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Erysipelas is a bacterial skin infection causing a bright red, sharply bordered, painful rash. It is most commonly caused by group A Streptococcus bacteria.
What is Erysipelas?
Erysipelas is an acute bacterial infection of the upper layers of the skin and the superficial lymphatic vessels. It is one of the more common skin infections and most frequently affects the lower legs and the face. The condition is characterized by its distinctive flaming red, clearly demarcated skin lesion, which historically gave rise to its common name St. Anthony's Fire.
Causes
Erysipelas is most commonly caused by beta-hemolytic Streptococci of group A (mainly Streptococcus pyogenes). In rare cases, Staphylococci or other bacteria may be involved. The bacteria enter the skin through small breaks or damaged areas, such as:
- Minor wounds, abrasions, or insect bites
- Fungal infections between the toes (tinea pedis / athlete's foot)
- Chronic wounds or ulcers
- Skin cracks caused by dryness or eczema
Risk Factors
Certain individuals are at higher risk of developing erysipelas, including those with:
- Chronic venous insufficiency or lymphedema
- Diabetes mellitus
- A weakened immune system
- Obesity
- A history of previous erysipelas episodes
Symptoms
Erysipelas typically has a sudden onset and progresses rapidly. The most characteristic symptoms include:
- Bright red, shiny skin lesion with a sharp, irregular border
- Local warmth and swelling of the affected skin area
- Pain and a sensation of tightness in the skin
- Systemic symptoms such as fever, chills, and fatigue
- Swollen lymph nodes near the site of infection
In severe cases, blisters (bullous erysipelas) or areas of tissue death (necrosis) may develop. Repeated episodes are referred to as recurrent erysipelas.
Diagnosis
Diagnosis is primarily clinical, based on the typical appearance and symptoms. Additional investigations may include:
- Blood tests to detect elevated inflammatory markers (CRP, white blood cell count)
- A swab from the site of entry if identifiable
- Ultrasound imaging if deeper tissue involvement is suspected
It is important to distinguish erysipelas from similar conditions such as deep vein thrombosis, erythema migrans (Lyme disease), or cellulitis (a deeper soft tissue infection).
Treatment
Erysipelas is treated with antibiotics effective against Streptococci. The first-line treatment is typically penicillin. In cases of penicillin allergy, alternatives such as cephalosporins or clindamycin are used.
Outpatient Treatment
Milder cases can be managed on an outpatient basis with oral antibiotics. Supporting measures include:
- Elevation of the affected limb to reduce swelling
- Cool compresses to soothe the skin
- Rest
- Treatment of the entry point (e.g., treating a fungal foot infection)
Inpatient Treatment
Severe cases, including those with high fever, extensive involvement, or immunocompromised patients, require hospital admission and intravenous antibiotic therapy. Without adequate treatment, erysipelas can lead to life-threatening complications such as sepsis or necrotizing fasciitis.
Prevention of Recurrence
For patients with frequent recurrences (more than twice per year), long-term low-dose antibiotic prophylaxis with penicillin may be considered. Treating underlying conditions such as lymphedema, venous insufficiency, or fungal foot infections is equally important in preventing relapse.
References
- German Dermatological Society (DDG): Clinical Guideline on Erysipelas and Cellulitis. AWMF Registry No. 013-006, 2019.
- Linder A, Christensson B, Sjölin J. Erysipelas: clinical and bacteriological spectrum and serological aspects. European Journal of Clinical Microbiology and Infectious Diseases, 2010.
- Swartz MN. Cellulitis. New England Journal of Medicine, 2004; 350(9): 904-912.
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Related search terms: Erysipelas + Erysipela + St. Anthony's Fire