History
In people with a strengthened immune system and the appropriate antibiotic treatment, erysipelas usually heals well. However, erysipelas must always be taken seriously, as complications can quickly arise. There is then the danger of phlebitis, or even blood poisoning (sepsis).If the bacteria spread into the depths, a life-threatening phlegmon can occur.
A phlegmon is an inflammation of the deep layers of the skin that can spread via muscles and tendons. As a rule, an existing erysipelas infection is not contagious for other people with intact skin and a well-functioning immune system. The bacteria causing the infection can be detected on the skin or mucous membranes of most people without causing difficulties there.
It only becomes dangerous when the bacteria can enter the body through a skin or mucous membrane defect and challenge the immune system with an infection. This can happen in particular when the physiological skin barrier (e.g. through skin tears, skin cuts, skin diseases, etc.) is destroyed and an entry portal is formed.
If this is the case, however, the immune system in healthy persons is usually still able to fight the pathogen spread and thus the infection. If, however, the body’s defenses are weakened for various reasons, the development of erysipelas can no longer be prevented. An erysipelas can therefore only be contagious if there is a transfer of bacteria from the patient’s wound area to existing skin defects of another immunocompromised person.
Guideline for an erysipelas
According to the guidelines of the German Dermatological Society (DDG) regarding streptococcal infections of the skin and mucous membranes, erysipelas is an invasive pathogen infection that affects 100 out of 100,000 inhabitants per year and occurs primarily on the legs or face. The diagnosis of erysipelas is usually made clinically, an entry portal (skin defects) and risk factors (weakness of the veins, diabetes mellitus, etc.) should always be sought, and the pathogen should be determined by means of a smear taken from the affected area in order to be able to start the appropriate antibiotic therapy.
As means of the first choice with a pure streptococcus infection then the administration of Penicillin G or V is considered, should however the suspicion of an additional infection with a further bacterium (usually Staphylococcus aureus) exist, must be fallen back however either to a Cephalosporin of the 1st generation or a Betalactam antibiotic with beta-lactamase inhibitor (Amoxicillin + Clavulansure). In case of penicillin allergy, the use of erythromycin or clindamycin is recommended. If there is a severe initial infection, antibiotic therapy is usually started by administering the antibiotic via the vein, but usually the administration of tablets can be switched to after 2-3 days if symptoms improve. Overall, the guideline for the treatment of erysipelas provides for a total antibiotic administration of 10-14 days, which can be supported by further symptomatic therapy (bed rest, elevation, cooling, blood coagulation inhibition, etc. ).
