Erysipelas

Definition
Erysipelas is a type of cellulitis (skin infection) generally caused by group A streptococci.

Causes, incidence, and risk factors

Erysipelas may affect both children and adults. The risk factors associated with this infection include local trauma (break in the skin), skin ulceration, and impaired venous or lymphatic drainage.

In the past, the face was most commonly involved yet now accounts for only up to 20% of cases. The lower extremities (legs) are affected in up to 80% of cases.

Symptoms

• An erysipelas skin lesion typically has a raised border that is sharply demarcated from normal skin. The underlying skin is painful, intensely red, hardened (indurated), swollen, and warm.
  
• Facial erysipelas lesions classically involve the cheeks and the bridge of the nose.
  
• Blisters may develop over the skin lesion.
  
• Fever and shaking chills are common.

The diagnosis of erysipelas is based on the characteristic appearance of the skin lesion. Skin biopsies are usually not needed. Blood cultures are rarely positive (up to 5% of the time).

Treatment
The cornerstone of therapy is treatment with antibiotics such as penicillin, which are active against streptococci. Depending on the severity, intravenous antibiotics may be used. In less severe cases, oral antibiotics may be sufficient. In individuals who have recurrent erysipelas, long-term antibiotics may be required.

Expectations (prognosis)

If appropriate antibiotic therapy is given early, the outcome is favorable. Skin changes may take up to a few weeks to normalize and peeling is common.

In some patients, streptococci may travel to the blood (bacteremia) and additional sites may be involved such as heart valves, joints, and bones.

Complications

• If bacteremia is present, infection may spread to other areas such as joints, bones, and heart valves.
  
• Septic shock
  
• Recurrence of infection

Prevention
Avoiding cuts and scrapes may reduce the risk for the development of erysipelas.

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