What Is Erysipelas?
Erysipelas is an acute bacterial skin infection that primarily affects the upper dermis and extends to the superficial lymphatics. It is most commonly caused by Streptococcus pyogenes (Group A Streptococcus) and presents with a well-defined, raised, red, and swollen rash. The condition requires prompt medical attention to prevent complications.
Causes and Risk Factors
Bacterial Origin
Erysipelas is most frequently caused by Streptococcus pyogenes. In some cases, Group B, C, or G streptococci can also be responsible. The bacteria enter the skin through minor cuts, abrasions, insect bites, ulcers, or surgical wounds.
Common Risk Factors
- Skin Barrier Disruptions: Cuts, wounds, eczema, fungal infections, or surgical incisions.
- Lymphedema: Poor lymphatic drainage increases susceptibility.
- Venous Insufficiency: Chronic venous disease weakens the skin’s defenses.
- Obesity: Increased risk due to poor circulation and skin folds.
- Diabetes Mellitus: Impaired immune response and delayed wound healing.
- Weakened Immune System: Conditions like HIV/AIDS, cancer, or immunosuppressive therapy.
Signs and Symptoms
Early Symptoms
- Sudden onset of redness and warmth
- Swelling with a raised, well-demarcated edge
- Pain and tenderness
- Fever, chills, and malaise
Advanced Symptoms
- Vesicles or bullae formation
- Lymphangitis (red streaks extending from the infected area)
- Regional lymphadenopathy (swollen lymph nodes)
Commonly Affected Areas:
- Face: Often associated with nasal or ear infections.
- Lower Limbs: Frequently seen in individuals with venous insufficiency.
- Upper Limbs: Common in post-mastectomy patients with lymphedema.
Diagnosis
Clinical Diagnosis
- Physical examination revealing sharply demarcated erythematous plaques.
- History of recent trauma, insect bites, or skin conditions.
- Fever and systemic symptoms indicating bacterial involvement.
Laboratory Tests
- Complete Blood Count (CBC): Shows elevated white blood cells (leukocytosis).
- C-Reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR): Indicate inflammation.
- Blood Cultures: Rarely positive but helpful in severe cases.
- Skin Swabs or Biopsy: Considered for recurrent or atypical cases.
Treatment and Management
Antibiotic Therapy
- First-Line Treatment: Penicillin V or Amoxicillin (oral) for mild to moderate cases.
- Severe Infections: Intravenous (IV) Penicillin G or Ceftriaxone.
- Penicillin Allergy: Clindamycin or Erythromycin as alternatives.
- MRSA Suspected: Vancomycin or Linezolid may be required.
Supportive Care
- Rest and Elevation: Reduces swelling and promotes recovery.
- Pain Management: NSAIDs or acetaminophen for fever and discomfort.
- Hydration: Ensuring adequate fluid intake supports immune function.
Hospitalization Criteria
- Severe systemic symptoms (e.g., sepsis)
- Extensive involvement or facial erysipelas
- Immunocompromised patients
- Failure of oral antibiotic therapy
Complications of Erysipelas
Local Complications
- Skin Necrosis: Tissue death due to severe infection.
- Abscess Formation: Pus-filled cavities requiring drainage.
- Chronic Lymphedema: Persistent swelling due to lymphatic damage.
Systemic Complications
- Sepsis: Bacterial spread to the bloodstream.
- Endocarditis: Infection of the heart valves.
- Glomerulonephritis: Immune-mediated kidney damage following streptococcal infection.
Prevention Strategies
Skin Care and Hygiene
- Regular washing with mild soap
- Moisturizing to prevent skin cracks
- Prompt wound care and antiseptic use
Managing Underlying Conditions
- Control of Diabetes: Maintaining blood glucose levels reduces susceptibility.
- Treatment of Fungal Infections: Prevents skin breaks.
- Compression Therapy: Helps with venous insufficiency and lymphedema.
Prophylactic Antibiotics
- Recommended for patients with recurrent erysipelas (e.g., Penicillin VK or Erythromycin in low doses).
