Overview

Erysipelas is a bacterial skin infection that affects the upper layers of the skin, causing sharply demarcated redness, swelling, and warmth in the affected area. It is most commonly caused by Streptococcus bacteria, particularly Streptococcus pyogenes (Group A Streptococcus). Erysipelas often appears on the face or legs but can develop on any part of the body. The condition can progress rapidly and may be accompanied by fever and systemic symptoms. Prompt treatment with antibiotics usually leads to full recovery, but untreated cases can result in complications such as abscess formation or bloodstream infections.

Causes

Erysipelas occurs when bacteria enter the skin through small cuts, abrasions, insect bites, or other breaks in the skin barrier. Common causes and risk factors include:

• Bacterial infection: Most cases are caused by Group A Streptococcus bacteria, though other streptococcal groups can also be responsible.
• Skin injuries: Cuts, scrapes, surgical wounds, or ulcers provide an entry point for bacteria.
• Existing skin conditions: Eczema, athlete's foot, or other dermatoses can predispose to infection.
• Weakened immune system: Individuals with diabetes, HIV, cancer, or other conditions that impair immunity are at higher risk.
• Lymphedema: Chronic swelling of limbs due to lymphatic system dysfunction increases susceptibility.
• Venous insufficiency: Poor circulation in the legs can lead to skin breakdown and infection.

Symptoms

Erysipelas is characterized by distinctive signs and symptoms that develop quickly, including:

• Red, swollen skin: Affected areas show bright red or reddish-orange patches with well-defined, raised edges.
• Pain and tenderness: The infected area is usually painful and warm to the touch.
• Fever and chills: Systemic symptoms often accompany erysipelas, with temperatures rising quickly.
• Blistering: In some cases, small blisters may form on the red skin.
• Swollen lymph nodes: Nearby lymph nodes may become enlarged and tender.
• Rapid progression: The redness can spread within hours, expanding in size if untreated.
• Fatigue and malaise: General feelings of sickness and tiredness are common.

Diagnosis

Diagnosis of erysipelas is mainly clinical, based on history and physical examination:

• Clinical appearance: The sharply bordered red rash with warmth and swelling is usually sufficient for diagnosis.
• Medical history: Recent skin injuries, infections, or chronic conditions may support the diagnosis.
• Blood tests: May show elevated white blood cell counts and inflammatory markers like C-reactive protein (CRP).
• Blood cultures: In more severe cases or if sepsis is suspected, blood cultures may be taken to detect bacteria in the bloodstream.
• Differential diagnosis: Erysipelas must be distinguished from cellulitis, which affects deeper skin layers, and other skin conditions such as contact dermatitis or venous eczema.

Treatment

Erysipelas requires prompt antibiotic therapy to control the infection and prevent complications:

• Antibiotics:
  • Penicillin is the first-line treatment, usually administered orally or intravenously depending on severity.
  • Alternative antibiotics like clindamycin or erythromycin may be used for penicillin-allergic patients.
• Supportive care:
  • Rest, leg elevation (if affecting the lower limbs), and hydration are important during treatment.
  • Pain relievers such as paracetamol or ibuprofen help manage fever and discomfort.
• Monitoring: Close observation for signs of spreading infection or complications like abscesses may be necessary.
• Treatment of underlying conditions: Managing contributing factors like fungal infections or lymphedema reduces recurrence risk.

Prognosis

With early and appropriate treatment, the prognosis for erysipelas is excellent:

• Rapid improvement: Symptoms usually start improving within 24 to 48 hours after starting antibiotics.
• Full recovery: Most people recover completely within 7 to 10 days without complications.
• Recurrence risk: Some individuals, especially those with lymphedema or chronic skin conditions, may experience recurrent episodes.
• Prevention: Good skin hygiene, prompt treatment of minor wounds, and managing chronic health conditions help prevent future infections.
• Complications are uncommon: When treated promptly, severe outcomes like sepsis or long-term damage are rare.

Timely medical care ensures effective treatment of erysipelas, minimizing complications and preventing recurrences in most cases.