Definition
Erysipelas is a common, acute infection (inflammation) in the lymphatic clefts of the skin. This inflammation spreads through the lymph vessels. It is caused by bacteria (see below). The entry point for these bacteria is injuries to the skin. Deep cracks (rhagades) or other injuries can let the pathogens in.
Causes of erysipelas
Erysipelas is caused by bacteria. These bacteria are called streptococci. Streptococcus pyogenes is the most common pathogen.
Rarely, staphylococci (Staphylococcus aureus = Staph. aureus) can be the trigger. Staph.
aureus is a germ that occurs physiologically on the skin. It occurs naturally and in every human being, for example in the armpit, the forehead-hairline or in the nasal vestibule. Erysipelas is more common in immunocompromised patients, i.e. especially elderly and ill people as well as people with an immunodeficiency (e.g. HIV infection).
Symptoms of erysipelas
At the entry portal there is a swelling which is red and burns. Usually this area is also overheated. These changes in the skin are always sharply defined and can also be accompanied by blistering.
The skin is taut and shiny. In addition to the localized pain, there may also be itching (skin itching). Within hours the inflammation expands along the lymph vessels (flame-like and irregular).
Healing begins from the centre. This disease usually occurs on the lower leg. In case of a facial infestation, where the connective tissue is looser, a rather diffuse redness and swelling can be detected.
The sharp border like on the lower leg is therefore missing. With the onset of erysipelas (erysipelas) or sometimes before it, general symptoms such as fever, chills and nausea occur. Possibly small injuries, which could have served as an entry point, are still visible.
In addition to the most frequent localization of an erysipelas on the legs, this bacterial skin infection often also occurs on the face and is then called facial erysipelas (ATTENTION: danger of confusion with a herpes zoster infection on the face, which is also often called facial erysipelas). The cause and mechanism of erysipelas on the face are the same as those on the legs. The entry point is often a minor injury in the nose or mouth area (e.g.
small cracks in the nostrils or corner of the mouth), small cuts in the facial skin (e.g. from shaving) or open spots. The symptoms (highly red, limited, scaly skin area, signs of inflammation, fever, pain, possibly blistering, etc.) are the same as for all other erysipelas; the lymph nodes that can be affected and swollen in the face in the case of erysipelas are usually located in the area of the neck, lower jaw or ear.
An immediate, antibiotic treatment is even more important in the case of facial erysipelas than in other affected areas of the body, as life-threatening complications are feared. These include, for example, involvement of the eye socket and the resulting risk to eye function, a blood clot in the cerebral veins (sinus vein thrombosis) or inflammation of the meninges and thus an infection that has spread to the brain. Erysipelas of the ear mainly affects the skin and subcutaneous tissue of the auricle, and the inflammation can also extend to the earlobe and the facial skin immediately adjacent to the ear.
The cause of the erysipelas is also here the penetration of bacteria (Group A Streptococci) through small skin defects of the ear. The main symptoms are strong redness, warming, painfulness and swelling of the auricle with accompanying fever, possibly swelling of the lymph nodes in the ear region and a general feeling of illness. It is important to examine the external auditory canal and the middle ear as part of the diagnostic procedure in order to detect any further spread of the inflammation in time. In addition to a co-infection of the middle and/or inner ear, erysipelas of the ear have the same life-threatening complications as facial erysipelas (meningitis, cerebral venous thrombosis, inflammation of the orbit). Therefore, an immediate initiation of an adequate antibiotic therapy is indispensable.
