Erysipelas - Causes, Symptoms, and Treatment

Introduction

Erysipelas is a superficial form of cellulitis, a common bacterial skin infection of the lower dermis and subcutaneous tissue. It is typically characterized by a localized area of erythema or redness, pain, swollen skin, and other systemic symptoms. If left untreated, cellulitis can be life-threatening. In addition, a potentially severe bacterial infection affects the skin. Erysipelas affects the upper dermis, and the features of erysipelas will extend into the superficial cutaneous lymphatics. Erysipelas is also known as Saint Anthony's fire due to its intense rash.

What Is Erysipelas?

Erysipelas is an infection affecting the skin's upper layers (superficial). The most common etiology of erysipelas is group A Streptococcal bacteria, most importantly Streptococcus pyogenes. Erysipelas usually present with a fiery erythematous rash, and the edges of the rash are raised that can easily be differentiated from the skin around it.

In addition, the affected skin may be warmer. It is believed that erysipelas will mainly affect the areas on the face. Still, recent studies suggest that the distribution of inflammation in erysipelas will also be observed in the legs in most cases. Therefore, the erythematous rash may also be present on the arms and trunk. Erysipelas also commences with minor skin trauma, including a bruise, wound, burn, and the incision at the site of a surgical incision or a wound. The rash occurs on the trunk, arms, and legs.

What Are the Causes of Erysipelas?

The etiology of erysipelas is caused by group A beta-hemolytic Streptococci such as Streptococcus pyogenes, Staphylococcus aureus, and methicillin-resistant strains (MRSA), Streptococcus pneumoniae, Klebsiella pneumoniae, and Yersinia enterocolitica. Haemophilus influenza has also been found rarely to cause erysipelas. Erysipelas usually affects infants and older people. Erysipelas has no gender or age preferences. However, erysipelas has some risk factors similar to cellulitis variants.

Some of the risk factors of erysipelas are mentioned below:

• People with a previous history of erysipelas.

• Trauma or injury in the skin barrier due to insect bites and ulcers.

• Chronic skin conditions like psoriasis, athlete's foot, and eczema.

• Other forms of skin injury like trauma, surgical wounds, and radiotherapy.

• Umbilical cord exposure in newborn babies.

• Vaccination site injury.

• Nasopharyngeal infection.

• Some venous diseases include gravitational eczema, leg ulceration, and lymphoedema.

• Immune deficiency conditions such as human immunodeficiency virus (HIV).

• Diabetes.

• Excessive alcohol intake.

• Excessive body weight and obesity.

• Nephrotic syndrome.

• Pregnancy.

What Are the Symptoms of Erysipelas?

The symptoms and signs of erysipelas are present with fevers, chills, and shivering. The clinical features of erysipelas mainly affect the skin of the lower extremities, and a key butterfly distribution feature is seen on the cheeks and across the nasal bridge.

Some other symptoms of erysipelas are given below:

• The affected skin in people with erysipelas will have a sharp and raised border.

• The localized lesion is tender and red.

• Skin appears bright red, firm, and swollen.

• Sometimes, the skin may be finely dimpled and resemble orange skin.

• In severe cases, necrosis and blisters are present.

• Skin bleeding may cause purpura.

• Cellulitis symptoms, including pain and increased warmth of affected skin, are present.

• In infants, the erysipelas symptoms are present in the umbilicus and diaper or napkin areas.

• Bullous erysipelas may arise due to streptococcal infection or co-infection with Staphylococcus aureus, methicillin-resistant strains, and MRSA.

• Malaise.

How to Diagnose Erysipelas?

Erysipelas is diagnosed with a history of symptoms and physical examinations.

There are various diagnostic methods, and some of the diagnoses of erysipelas are mentioned below:

• Blood examinations increased white blood cell count.

• Increased C reactive protein.

• Blood culture.

• Imaging techniques include magnetic resonance imaging (MRI) and computed tomography (CT).

• Skin biopsy.

What Is the Treatment of Erysipelas?

The treatment is based on the management of symptoms and medical therapy. The symptoms are managed with some general measures. Antibiotics are used for 10 to 14 days.

The various treatment modes for treating erysipelas are mentioned below.

• Cold compress to relieve discomfort.

• Limb elevation can reduce swelling.

• Saline dressings are done to improve wound care.

Medical therapy for erysipelas is mentioned below:

• Administration of antibiotics such as Penicillin, Clindamycin, or Erythromycin by oral route.

• Intravenous Penicillin.

• Vancomycin for facial erysipelas.

• Erythromycin is an alternative medication option for individuals who are allergic to Penicillin.

• Antiallergic drugs, mineral complexes, and vitamins are the additional supportive medications prescribed along with antibiotics to increase their effectiveness.

What Is the Differential Diagnosis of Erysipelas?

The signs and symptoms of erysipelas are similar to other skin conditions. Therefore, comparing symptoms will be helpful in differential diagnosis and avoiding misdiagnosis.

Some of the differential diagnoses of erysipelas are mentioned below:

• Orbital Cellulitis - Orbital cellulitis is a bacterial skin infection. It is characterized by tissue inflammation surrounding the eye. Pain in the eye socket, abnormal eyeball protrusion, impaired eye movement, eyelid swelling, and fever are the symptoms.

• Herpes Zoster - Herpes zoster is a central nervous system viral infection. Blisters, neural pain, and severe skin itching are present. The affected skin is typically susceptible and painful.

• Contact Dermatitis - Systemic contact dermatitis is a common skin inflammatory condition due to systemic exposure to allergens. Systemic contact dermatitis can be caused due to allergens, including metals, drugs, and sometimes even foods. The other name for systemic contact dermatitis is allergic contact dermatitis syndrome and baboon syndrome; Baboon syndrome is also called symmetrical drug-related intertriginous and flexural exanthema or SDRIFE, the variant of systemic contact dermatitis.

• Dermatolymphangioadenitis - Dermatolymphangioadenitis (DLA) is an erythematous skin disorder. Symptoms may include malaise, fever, and chills. DLA is most often followed after surgery, trauma, and lymphedema dermatitis. The periodic low doses of Benzathine penicillin will prevent the recurrence of DLA.

What Are the Severe Complications of Erysipelas?

In case of severe infections, erysipelas has complications. Persistent risk factors and any lymphatic damage can cause severe outcomes.

Some of the difficulties of erysipelas are mentioned below:

• Chronic abscess.

• Thrombophlebitis.

• Chronic leg swelling.

• Gangrene.

• Infective endocarditis.

• Septic arthritis.

• Bursitis.

• Tendonitis.

• A kidney condition affecting children, like post-streptococcal glomerulonephritis

• Cavernous sinus thrombosis is a dangerous blood clot that can spread to the brain.

• Streptococcal toxic shock syndrome may rarely occur.

How to Prevent Erysipelas?

Preventive measures are taken to avoid or reduce the risk of erysipelas.

• Properly cleaning and covering wounds is essential for individuals with open injuries.

• Effectively treat underlying skin conditions such as athlete's foot or eczema to prevent the recurrence of erysipelas.

• Diabetes patients should be extra cautious in maintaining good foot hygiene.

• It is always advisable to seek medical supervision in case the symptoms arise.

• People with a history of recurrence of erysipelas should complete prolonged antibiotic treatment to prevent further reinfection.

Conclusion

Erysipelas is a skin infection caused by group A Streptococcal bacteria, most importantly Streptococcus pyogenes. Symptoms of erysipelas include bright red skin in association with fever. The most commonly affected areas are the face and lower extremities. The symptoms of erysipelas are similar to cellulitis. The diagnosis is made with a blood evaluation. The treatment of erysipelas includes antibiotics administration. However, erysipelas is not a life-threatening condition and responds well to treatment.