Introduction
Erysipelas is an acute bacterial infection of the skin and subcutaneous tissue, usually caused by streptococci. It is a semi-urgent condition in dermatology because of the risk of local and systemic complications. It mainly affects the legs and, more rarely, the face. Early antibiotic treatment leads to rapid improvement.
Symptoms
- Red, hot, painful and well-defined patch
- Marked local swelling (oedema)
- Feeling of tight skin
- High fever and chills
- Feeling generally unwell
- Possible swollen regional lymph nodes
- Possible associated lymphangitis
- Rapid spread of the lesion if left untreated
Causes
- Infection, usually with group A streptococcus
- A break in the skin is a common entry point
- cracks between the toes wounds ulcers fungal infections
- cracks between the toes
- wounds
- ulcers
- fungal infections
- Contributing factors
- venous insufficiency lymphoedema diabetes obesity weakened immune system
- venous insufficiency
- lymphoedema
- diabetes
- obesity
- weakened immune system
Diagnosis
- Clinical diagnosis based on the typical appearance and fever
- Possible blood tests: raised inflammatory markers raised white cell count
- raised inflammatory markers
- raised white cell count
- Blood cultures if fever is high or the patient is vulnerable
- Differential diagnosis with: non-necrotising bacterial cellulitis deep vein thrombosis inflammatory skin conditions
- non-necrotising bacterial cellulitis
- deep vein thrombosis
- inflammatory skin conditions
Treatments
- Amoxicillin (first-line)
- Alternatives depending on allergy or circumstances
- macrolides clindamycin
- macrolides
- clindamycin
- Strict rest of the affected limb
- Elevation of the limb
- Painkillers and fever-reducing medicines
- Treatment of the entry point
- No specific device-based treatment
- Standardised medical care
Management
Prompt dermatological or medical care
Hospital admission if: severe forms significant comorbidities facial involvement
severe forms
significant comorbidities
facial involvement
Prevention of recurrences by correcting contributing factors
Regular follow-up for recurrent erysipelas