This book describes Erysipelas, Diagnosis and Treatment and Related Diseases
Erysipelas is a bacterial infection in the upper layer of the skin.
It is similar to another skin disorder known as cellulitis, which is an infection in the lower layers of the skin.
Both conditions are similar in appearance and are treated in the same way.
Erysipelas involves the upper dermis and extends into the superficial cutaneous lymphatics.
It is also termed St Anthony's fire due to the intense rash linked with it.
Causes:
Erysipelas is usually caused by the Group A Streptococcus bacterium, the same bacterium that causes strep throat.
Erysipelas occurs when Group A Streptococcus bacteria penetrate the outer barrier of the skin.
These bacteria normally live on the skin and other surfaces without causing any harm.
However, they can enter the skin through a cut or a sore and cause an infection.
Conditions that cause breaks in the skin, such as athlete's foot and eczema, can sometimes lead to erysipelas.
The infection results in large, raised red patches on the skin.
This is sometimes accompanied by other symptoms, including blisters, fevers, and chills.
Erysipelas most frequently occurs on the face 20% and legs 80%.
Erysipelas may also occur when the bacteria spread to nasal passages following an infection in the nose and throat.
Erysipelas often improves with treatment.
The infection can usually be treated effectively with antibiotics.
Unlike cellulitis, almost all erysipelas is caused by Group A beta hemolytic streptococci (Streptococcus pyogenes).
Staphylococcus aureus, including methicillin-resistant strains (MRSA), Streptococcus pneumoniae, Klebsiella pneumoniae, Yersinia enterocolitica, and Hemophilus influenzae have also been found rarely to cause erysipelas.
Symptoms
Symptoms and signs of erysipelas are normally abrupt in onset and often accompanied by fevers, chills and shivering.
Erysipelas predominantly affects the skin of the lower limbs, but when it involves the face, it can have a characteristic butterfly distribution on the cheeks and across the bridge of the nose.
When erysipelas affects the face, the swollen area usually includes the nose and both cheeks.
The affected skin has a very sharp, raised border.
Diagnosis:
The doctor can usually diagnose erysipelas by simply performing a physical exam and asking the person about the symptoms.
During the exam, the doctor will check for swollen, reddened, and warm areas of skin in the face and legs.
Tests may reveal:
Raised white cell count
Raised C-reactive protein
Positive blood culture identifying the organism
MRI and CT are undertaken in case of deep infection.
The skin biopsy findings can show the presence of erysipelas.
Treatment
Most people with erysipelas can be treated at home, but some may require treatment in a hospital.
Depending on the severity of the condition, the treatment plan can include home remedies, medication, or surgery.
Home Care
Usually, the affected part of the body must be raised higher than the rest of the body to reduce swelling.
If the leg is affected, the person should try to rest as much as possible with the leg elevated above the hip.
It is also important to drink plenty of fluids and to get up and walk around from time to time.
Antibiotics
Oral or intravenous penicillin is the antibiotic of first choice.
Erythromycin, roxithromycin or pristinamycin may be used in patients with penicillin allergy.
Vancomycin is used for facial erysipelas caused by MRSA
Treatment is usually for 1014 days
More serious cases of erysipelas are generally treated at the hospital, where antibiotics can be given through a vein (IV).
Surgery may be needed to cut away the dead tiss