Erysipelas

Erysipelas

Key Points
Condition is a form of Cellulitis, a bacterial infection affecting the skin, predominant in the elderly and infants, caused by a specific bacteria.
Condition can cause fever and chills, and results in red, swollen, dimpled or blistered skin with a well-defined raised border.

Erysipelas is a superficial form of Cellulitis, a potentially serious bacterial infection affecting the skin. Erysipelas most often affects infants and the elderly, but can affect any age group. Risk factors are similar to those for other forms of Cellulitis. However, unlike Cellulitis, almost all Erysipelas is caused by the bacteria Streptococcus pyogenes.

Erysipelas predominantly affects the skin of the lower limbs, but when it involves the face it can take a butterfly pattern on the cheeks and bridge of the nose. Symptoms and signs of Erysipelas are usually abrupt and often accompanied by fevers, chills and shivering. Affected skin is distinguished from other forms of Cellulitis by a well-defined, raised border. The affected skin is red, swollen and may be finely dimpled like an orange skin or blistered. Bleeding into the skin may cause purple patches. Cellulitis does not usually exhibit such marked swelling but shares other features with Erysipelas such as pain and increased warmth of affected skin.

Differential Diagnosis (Other conditions with similar appearance)

Erythema annulare centrifugum
Stasis Dermatitis

Diagnosis
Key Points
Diagnosis is performed through microscopy and clinical investigation to confirm correct diagnosis.

Treatment
Key Points
Most bacterial infection can be combated with antibiotics, Penicillin being preferred but Erythromycin as an alternative for those with allergies.
Treatment takes up to two weeks, but the skin changes may take even longer to resolve.
Recurrence is possible.

Most streptococcal bacteria causing Erysipelas are sensitive to antibiotics with Penicillin, either orally or intravenously (if patient is very unwell), as the preferred antibiotic. Erythromycin may be used as an alternative in patients with Penicillin allergy. Treatment is usually for 10-14 days, and while signs of general illness resolve within a day or two, the skin changes may take some weeks to resolve completely. No scarring occurs.

Erysipelas recurs in up to one third of patients. If patients have recurrent attacks, long term preventive treatment with Penicillin may be considered.