Erysipelas – Causes, Symptoms and Treatment
Erysipelas is an acute bacterial skin infection causing sharply defined redness, swelling, and pain. It requires prompt antibiotic treatment to prevent complications.
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Erysipelas is an acute bacterial skin infection causing sharply defined redness, swelling, and pain. It requires prompt antibiotic treatment to prevent complications.
What is Erysipelas?
Erysipelas is an acute bacterial infection of the skin and superficial lymphatic vessels. It is one of the most common skin infections worldwide and most frequently affects the lower legs and the face. The condition is characterized by a rapidly spreading, sharply demarcated area of redness and swelling. Without prompt treatment, erysipelas can progress to serious complications.
Causes
Erysipelas is caused primarily by beta-hemolytic Group A Streptococci (Streptococcus pyogenes). Less commonly, other streptococcal groups or staphylococci may be responsible. The bacteria enter the skin through small breaks such as cuts, cracks, insect bites, or fungal infections of the foot (tinea pedis).
Risk factors that increase susceptibility include:
- Chronic fungal infections of the feet (athlete's foot)
- Lymphedema or chronic venous insufficiency
- Weakened immune system (e.g., due to diabetes mellitus or immunosuppressive therapy)
- Obesity
- Previous episodes of erysipelas (tendency to recur)
Symptoms
Erysipelas typically develops rapidly, beginning with systemic symptoms followed by characteristic skin changes:
- Systemic symptoms: High fever (often above 39 °C / 102 °F), chills, fatigue, and headache
- Local skin symptoms: Sharply demarcated, fiery red, raised, warm, and painful skin area that spreads quickly
- Swollen lymph nodes near the affected region
- In severe cases: blistering (bullous erysipelas) or skin hemorrhages
Diagnosis
Erysipelas is usually diagnosed clinically based on its characteristic appearance and the medical history. Additional diagnostic tests may include:
- Blood tests: elevated inflammatory markers (CRP, white blood cell count, ESR)
- Blood cultures: to rule out sepsis (bloodstream infection)
- Skin swab (occasionally, in atypical presentations)
- Ultrasound: to exclude deeper infections such as necrotizing fasciitis
Treatment
The primary treatment for erysipelas is antibiotic therapy targeting streptococcal bacteria:
- Penicillin is the first-line antibiotic – given orally for mild cases and intravenously for severe cases or complications
- Alternatives for penicillin-allergic patients: clindamycin or erythromycin
- Duration of treatment: typically 10–14 days
Supportive measures include:
- Elevation of the affected limb to reduce swelling
- Cooling compresses applied to the affected area
- Rest during the acute phase of illness
- Treatment of the entry site (e.g., athlete's foot) to reduce the risk of recurrence
Complications and Recurrence
If left untreated or inadequately managed, erysipelas can lead to serious complications including abscess formation, necrotizing fasciitis (a life-threatening deep tissue infection), or sepsis. Because erysipelas damages lymphatic vessels, recurrent episodes are common. In patients with frequent relapses, long-term prophylaxis with low-dose penicillin may be considered.
References
- Stevens D.L., Bisno A.L. et al. - Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections. Clinical Infectious Diseases, 2014.
- Chira S., Miller L.G. - Staphylococcus aureus is the most common identified cause of cellulitis: a systematic review. Epidemiology and Infection, 2010.
- World Health Organization (WHO) - Antimicrobial resistance and skin infections: global guidelines, 2022.
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