Erysipelas, a skin infection

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Legs are the most common site of this infection caused by bacteria.

[caption id="attachment_6708" align="alignleft" width="180" caption="Leg is a common site of infection."]Erysipelas[/caption]

What is Erysipelas?

Erysipelas is a type of skin infection caused by group A streptococcus bacteria. This condition affects both children and adults. Historically face was affected in most of the cases but these days legs are the common site of infection in 80% of cases.

Causes of erysipelas:

Most cases of erysipelas are due to streptococcus pyogenes. The rash is due to an exotoxin (a toxin secreted by microorganisms).

Erysipelas infection can enter the skin through minor trauma, insect bites, dog bites, eczema, surgical incisions and often originate from streptococcal bacteria in person’s own nasal passages.

Erysipelas does not affect the subcutaneous tissue (third layer of the skin).

The following can put one at risk of erysipelas infection:

  • A cut in the skin
  • Diabetes Mellitus
  • Immune deficiency
  • Alcoholism
  • Skin ulceration and fungal infection
  • Problems with drainage through the veins or lymph system
  • Skin sores

Symptoms of erysipelas:

  • Blisters
  • Fever with shaking chills
  • Painful, red, swollen and warm skin underneath the lesion
  • Erythematous skin lesions with a raised border.
  • Sores on the cheeks and bridge of the nose.
  • Swollen lymph nodes and lymphedema may occur.
  • More severe infection can lead to vesicles, bullae and petechiae with possible skin necrosis.

Diagnosing erysipelas

Diagnosis is usually based on the appearance of the skin with well demarcated rash inflammation, and skin biopsy is not required.

Elevation of the antistreptolysin titre (a blood test used to measure antibodies) occurs after around 10 days of illness.

MRI and bone scintigraphy (a diagnostic technique in which a two-dimensional picture of internal body tissue is produced through the detection of radiation) are helpful when early osteoarticular (involving or affecting bones) involvement is suspected.

Treatment for erysipelas

Antibiotics, such as penicillin, erythromycin is used to treat infection. Those who have repeated episodes of erysipelas may require long-term antibiotics. Hospitalisation for close monitoring and intravenous antibiotics are recommended in severe cases, in infants, elderly people and patients who have an  immunodeficiency.

Elevation and rest of the affected limb are recommended in erysipelas treatment to reduce local swelling, inflammation and pain. Patients with acute infection involving extremities should be encouraged to limit their activity.

Saline wet dressings should be applied to ulcerated and necrotic lesions and changed every 2-12 hours, depending on the severity of infection.

Debridement (medical removal dead, damaged and infected tissue to improve the healing potential of the remaining healthy tissue) is necessary only in severe infections with necrosis and gangrene.

Prognosis of erysipelas

Prognosis for patients is excellent. With continuous treatment most of the cases become normal in a few weeks. Complications are not life threatening. However, local recurrence has been reported in up to 20% of cases with predisposing conditions.

Complications seen in erysipelas

  • In some cases bacteria may travel to the blood and result in a condition called bacteremia. The infection may travel to heart valves, leading to infective endocarditis (inflammation of the inside of the lining of the heart chambers).
  • Other complications can include return of infection and septic shock.
  • Necrotising fascitis commonly known as flesh-eating disease or flesh-eating bacteria syndrome.

Prevention of erysipelas

Skin should be kept healthy. Dry skin and cuts and scrapes should be avoided.

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