Erysipelas Disease

BASICS

DESCRIPTION

Bacterial cellulitis involving the superficial skin and lymphatics usually due to group A streptococcus. Usually acute, but a chronic recurrent form also exists.

System(s) affected: Skin/Exocrine
Genetics: N/A
Incidence/Prevalence in USA: Unknown
Predominant age: Usually infants and adults over 40. Greatest in elderly (> 75 years).
Predominant sex: Male = Female

SIGNS AND SYMPTOMS

Prodrome of malaise, fever and chills
Headache, vomiting are prominent
Arthralgias
Pruritus
Skin discomfort
Vesicles
Facial redness
Acute onset of erythema
Begins as erythematous patch
Sharply demarcated raised border
Center of lesion clears as periphery spreads
Desquamation and vesicle formation can occur
Face is the most common area involved, especially nose and ears
Chronic form may recur hours to years after initial episode
Chronic form usually recurs at site of the previous infection
Fever is usually the differentiating factor among similar skin manifestations

CAUSES

Group A beta-hemolytic streptococcus primarily; occasionally other strep groups or staph

RISK FACTORS

Operative wounds
Fissured skin (especially at the nose and ears)
Any inflamed skin
Traumatic wounds/abrasions
Leg ulcers/stasis dermatitis
Chronic diseases (diabetes, malnutrition, nephrotic syndrome)
Immunocompromised or debilitated individual

DIAGNOSIS

LABORATORY

Leukocytosis (usually > 15,000)
Strep may be cultured from exudate or from non-involved sites
Antistreptolysin (ASO), streptozyme, anti-DNase may be helpful
Blood culture (< 5% positive)

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

Edema
Vasodilation and enlarged lymphatics
Infiltration of polymorphonuclear leukocytes, lymphocytes and other inflammatory cells
Endothelial cell swelling
Gram positive cocci

SPECIAL TESTS

N/A

IMAGING

N/A

DIAGNOSTIC PROCEDURES

None

TREATMENT

APPROPRIATE HEALTH CARE

Outpatient

GENERAL MEASURES

Symptomatic treatment of aches and fever
Adequate fluid intake
Local treatment with cold compresses

SURGICAL MEASURES

N/A

ACTIVITY

Bedrest with activity based on severity of illness

DIET

No special diet

PATIENT EDUCATION

Importance of completing medication regimen prescribed

FOLLOW UP

PREVENTION/AVOIDANCE

Maintenance antibiotics for chronic recurrent cases
Men who shave within five days of facial erysipelas are more likely to have a recurrence
In recurrent cases, search for other possible source of streptococcal infection (e.g., tonsils, sinuses, teeth, toenails, etc.)

POSSIBLE COMPLICATIONS

Bacteremia
Scarlet fever
Pneumonia
Abscess
Embolism
Gangrene
Meningitis
Sepsis
Death

EXPECTED COURSE AND PROGNOSIS

Adequate treatment results in full recovery
Chronic edema/scarring can result from chronic recurrent cases
Rarely elephantiasis may result from chronic recurrent cases
Untreated cases sometimes will resolve spontaneously

MISCELLANEOUS

ASSOCIATED CONDITIONS

N/A

AGE-RELATED FACTORS

Pediatric:

Group B strep may be a cause in neonates/infants
Abdominal involvement more common in infants
Face, scalp, and leg common in older children

Geriatric: Aging alone is not a cause of impotence
Others:

Fever may not be as prominent
More prone to complications
High output cardiac failure may occur in debilitated patients with underlying cardiac disease
Face and lower extremity most common areas

PREGNANCY

N/A

OTHER NOTES

Patients on systemic steroids may be more difficult to diagnose since signs and symptoms of the infection may be masked by anti-inflammatory action of the steroids

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

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