Symptoms
Erysipelas manifests as a painful, hyperthermic, clearly demarcated, shiny, and flaming redness of the skin with swelling. In addition to local reactions, flu-like general symptoms such as fever, chills, nausea, and poor general condition occur. The lymphatic channels are inflamed, the lymph nodes swell and hurt. Young and old people are most affected. Typically, the legs and central face are infected, and in newborns, the area around the umbilicus. Possible complications include blistering, skin necrosis, hemorrhage, sepsis, meningitis, inflammation of the inner lining of the heart (endocarditis), necrotizing fasciitis, and toxic shock syndrome. The disease can be fatal in the worst cases.
Causes
The cause of the disease is an acute bacterial infection of the skin and lymphatic vessels. Only the upper layers of the skin are affected, i.e., the epidermis and dermis. Therefore, it is also called superficial cellulitis, since the actual cellulitis extends further into the subcutis. The pathogens found are mainly β-hemolytic streptococci of group A (GABHS) as well as groups B, C, and G. More rarely, other germs such as are also considered. The infection often originates from pre-damaged skin (e.g., lower leg ulcer, minor injuries, rhagades, skin diseases, athlete’s foot, insect bites).
Diagnosis
Diagnosis is made on the basis of clinical presentation. Laboratory methods or imaging techniques may be used to differentiate erysipelas from other conditions. Numerous skin diseases are possible differential diagnoses, for example, insect bites, urticaria, herpes zoster, angioedema, contact dermatitis, rosacea, cellulitis, lupus erythematosus, and erysipeloid. Erysipeloid is an occupational disease and a zoonosis caused by the bacterium (see there).
Prevention
Good wound care and, in newborns, good umbilical disinfection are recommended for prevention. In cases of recurrent erysipelas, the port of entry should be sanitized, and preventive antibiotic therapy may also be indicated.
Drug treatment
Antibiotics:
- Systemic antibiotics to which the pathogens are sensitive are used for drug treatment. Penicillins (e.g., amoxicillin + clavulanic acid) are considered the first-line agents; alternatively, macrolides, cephalosporins, and clindamycin, among others, are also used. Hospitalization is indicated, especially in neonates and immunocompromised patients.
NSAIDS:
- Furthermore, non-steroidal anti-inflammatory drugs such as ibuprofen as well as paracetamol are administered against the inflammation and fever.
The literature also mentions glucocorticoids such as prednisolone against the inflammation, the application of wet compresses with antiseptic addition, as well as antibiotic ointments.
