Erysipelas

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Erysipelas is a type of skin infection caused by bacteria. It is very common, often arising from a tiny break in the skin, and can sometimes be serious, especially in people with diabetes and certain other underlying medical problems. The bacteria that most often cause it are the gram positive bacteria group A streptococci and Staphylococcus aureus.

Erysipelas is treated with antibiotics.

The related skin infection cellulitis affects the deeper layers of the skin.

Facial erysipelas caused by invasive Streptococcus. Source: CDC


Contents

Other Names

  • St. Anthony's fire
  • Non-necrotizing dermohypodermitis
  • Acute bacterial dermohypodermitis

Types

Bullous erysipelas is a more severe form of the disease.[1]

Signs and Symptoms

The hallmark of erysipelas is a hot, red skin rash, with sharply defined raised borders, usually located on the face, arms, or legs. The rash may be tender or itchy, and there may be streaky red marks around the rash, indicating involvement of the lymphatic system. Flu-like symptoms such as achiness and fever may precede the infection.[2]

Bullous erysipelas includes large "bubbles", or bullae, on the skin.

Causes

Streptococcus bacteria are usually the cause of erysipelas. Streptococcus bacteria, or Strep as they are often called, can be divided into several groups based on a certain component in the bacteria's outer wall. Group A and group B strep cause most human disease, and group A is the type that causes erysipelas.

The most important species of group A Streptococcus is Streptococcus pyogenes. Besides causing erysipelas, it can also cause cellulitis as well as the other very serious group A strep infections necrotizing fasciitis and streptococcal toxic shock syndrome. Group A strep are also responsible for "Strep throat".
2173 streptococcus.jpg
Gram stain of Streptococcus. Source: CDC

Erysipelas should not be confused with erysipeloid, a skin infection caused by the Gram-positive bacillus Erysipelothrix.

Unlike in the related disease cellulitis, erysipelas is not thought to be caused by Staphylococcus species. The exception is in complicated cases of erysipelas such as bullous erysipelas, in which Staphylococcus aureus is involved, and even MRSA, or methicillin-resistant S. aureus.[1]

Diagnosis

Diagnosis is made by looking at the skin and listening to the history. Further tests are seldom needed.
Group A S. pyogenes showing its ability to break open red blood cells, a property called beta hemolysis
. The broken cells show up as a white halo around the circular colonies in the center. Source: CDC]]

Treatment

Depending on how severe the infection is, a healthcare provider will prescribe either oral, intramuscular, or intravenous (through the vein) antibiotics. For most people, penicillin is effective against the Group A Streptococcus that causes erysipelas. Penicillin can be given in the form of pills or shots. People with a mild allergic reaction to penicillin can usually take a cephalosporin, a type of drug that is related to penicillin but does not usually provoke an allergic reaction. People dangerously allergic to penicillin can be treated with erythromycin or azithromycin. Keeping the infected areas elevated is also important.

In bullous erysipelas, antibiotics that can treat the resistant germ MRSA may be required.[1]

In Europe, the drugs roxithromycin[3] and pristinamycin are used for the treatment of erysipelas.[4]

Prevention

Especially in people with weakened immune systems or who have diabetes, it is important to keep minor abrasions, cuts, bruises, and burns clean and to avoid repeated skin trauma. This includes excellent foot care, as cracks between the toes can cause such infections in diabetics. People with peripheral edema, or swelling in the legs, from [[Heart Failure|heart failure, liver conditions and other conditions may benefit from wearing skin compression stockings to help prevent skin breakdown and the erysipelas that may result.

Chances of Developing Erysipelas

Like the related disease cellulitis, erysipelas usually begins with a minor incident, such as a bruise. It can also begin at the site of a burn, surgical cut, or wound, or any other break in the skin. These breaks in the skin's defenses allow bacteria to enter and begin an infection.

Many people are carriers of the bacteria that cause erysipelas. The germs live in their skin or inside their noses.

Risk factors

Besides broken or damaged skin, the following circumstances can raise a person's risk of getting erysipelas.

  • Diabetes: Diabetes is a risk factor for many serious infections, as the immune system is somewhat suppressed in people with the disease.
  • Alcohol abuse[5]
  • Homelessness[6]
  • Nephrotic syndrome[4]
  • Immunosuppression: People with a faulty or damaged immune system, such as people with HIV or those receiving chemotherapy or taking long courses of steroids, are at higher risk for infections like cellulitis.
  • Impaired circulation: People who have peripheral vascular disease, in which the arteries to the arms and legs are not bringing enough blood, and people with chronically swollen body parts, in which veins are not draining the blood adequately, are at higher risk for cellulitis. A brisk blood circulation is an important part of keeping infections at bay, and sluggish circulation removes this defense.

Clinical Trials

For a list of American government-sponsored clinical trials that are studying erysipelas, click here.

References

  1. 1.0 1.1 1.2 Krasagakis K, Samonis G, Maniatakis P, Georgala S, Tosca A. Bullous erysipelas: clinical presentation, staphylococcal involvement and methicillin resistance. Dermatology. 2006;212(1):31-5. Abstract | [Full Text]
  2. Stulberg DL, Penrod MA, Blatny RA. Common bacterial skin infections. Am Fam Physician. 2002 Jul 1;66(1):119-24. Abstract | Full Text
  3. Bernard P, Plantin P, Roger H, Sassolas B, Villaret E, Legrain V, Roujeau JC, Rezvani Y, Scheimberg A. Roxithromycin versus penicillin in the treatment of erysipelas in adults: a comparative study. Br J Dermatol. 1992 Aug;127(2):155-9. Abstract
  4. 4.0 4.1 Davis L. Erysipelas. eMedicine.com.
  5. Jorup-Rönström C. Epidemiological, bacteriological and complicating features of erysipelas. Scand J Infect Dis. 1986;18(6):519-24. Abstract
  6. Raoult D, Foucault C, Brouqui P. Infections in the homeless. Lancet Infect Dis. 2001 Sep;1(2):77-84. Abstract

External Links

SkinAtlas.com: Erysipelas images

Medpedia-logo.gif The basis of this article is contributed from Medpedia.com These articles are licensed under the GNU Free Documentation License It may have since been edited beyond all recognition. But we thank Medpedia for allowing its use.
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