Complications of an erysipelas
If the course of the disease is particularly severe, blisters may form within the affected area.This is medically called bullous erysipelas (bulla = bladder). If bleeding is present, the disease is called hemorrhagic erysipelas (heme = red blood pigment). The most severe form is called gangrenous erysipelas (gangrene = a disease caused by bacteria that causes individual body parts to “rot”).
A further complication is the tendency to recur, i.e. erysipelas occurs repeatedly. The recurrences often occur at the same place. The recurrences can lead to adhesions of the lymphatic system and thus to lymphedema. Lymphedema is the swelling caused by the transfer of lymph fluid into the surrounding tissue.
Diagnosis
To diagnose erysipelas, the symptoms and the appearance of the disease are mainly consulted. The typical combination of swelling, reddening, warming and sharp limitation at the predilection sites described above (especially lower leg) hardly allows any other diagnosis. Certain laboratory values can also be helpful.
In most cases the leukocytes (white blood cells) are elevated, the BSG (blood cell sedimentation rate) and the CRP (C-reactive protein, CRP value) are prolonged. All three are signs of inflammation. However, the values are also very unspecific.
They are also elevated in other types of inflammation (e.g. appendicitis or flu-like infections). If you suspect an erysipelas, you should not ignore the search for the entry port. If the first signs of erysipelas appear, an adequate therapy should be initiated as soon as possible to avoid serious complications (such as lymph congestion, phlebitis, blood poisoning, kidney inflammation, etc.)
as the disease progresses. The therapy that every treating physician usually resorts to first – the so-called drug of choice – is the administration of antibiotics in high doses. This is an antibiotic from the group of penicillins or cephalosporins, which, depending on the severity of the disease, is administered either via the vein (i.v.
; then mostly as an in-patient in hospital) or as a tablet (oral; as an out-patient therapy with the family doctor). Since in most cases it concerns group A streptococci (Streptococcus pyogenes) and these normally react sensitively to penicillin, the administration of this antibiotic should result in the containment and control of erysipelas. If the patient is allergic to penicillin or in exceptional cases, if the bacteria causing the allergy are resistant to penicillin, erythromycin or clindamycin is used.
If it is suspected that other pathogens are involved in the infection in addition to the classic erysipelas bacteria (mixed infections, e.g. with Staphylococcus aureus), cephalosporin is used. The antibiotic should be taken or given via the vein for about 10-14 days, even if the symptoms improve significantly after only a few days. In addition to the antibiotic therapy, painkillers and antipyretic agents (such as ibuprofen, paracetamol) can be given to alleviate accompanying symptoms of erysipelas.
In addition, the part of the body affected by erysipelas should be moved as little as possible, so that in most cases bed rest is prescribed. It may also be advisable to put on a splint and elevate the body if erysipelas occurs on one arm or leg. In addition, cooling the diseased area has an additional analgesic effect and reduces the swelling.
Since immobilization or bed rest increases the risk of a blood clot (thrombosis) forming in the veins, thrombosis prophylaxis may be necessary from the outset (administration of a blood-thinning, anticoagulant). The application of compression stockings or a compression bandage after the initial swelling of the affected area has subsided can also prevent a renewed accumulation of fluid in the tissue and promote the return flow of blood in the veins. In addition to acute treatment, it is also important to find the entry point for the erysipelas pathogens (skin injuries), which should be healed as quickly as possible.
