Skin-nontumor / Clinical dermatology
Infectious disorders
Erysipelas

Author: Ha Kirsten Do, M.D. (see Authors page)

Revised: 23 May 2016, last major update September 2010

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PubMed Search: Erysipelas [title]

Definition / General
  • Erysipelas is a superficial form of cellulitis and is almost always caused by Streptococcus pyogenes (Wikipedia)
Epidemiology
  • Can affect any age group but commonly affect infants and elderly
  • Tracing back to the Middle Ages, it historically occurred on the face and was referred to as St. Anthonys Fire, after an Egyptian healer (eMedicine)
  • More recently, its distribution has shifted to the lower extremities due to an aging population with risk factors such as leg venous insufficiency; 75% of cases now occur in legs (Int J Dermatol 2010;49:1012)
  • Its incidence has declined throughout the 20th century, possibly due to antibiotics and improved sanitation
Clinical Features
  • Lesions predominantly appear on lower limbs, but when it involves the face, it gives rise to a characteristic butterfly distribution on the cheeks and bridge of the nose
  • Usually abrupt onset; can be distinguished from other forms of cellulitis by a sharply demarcated, raised border
  • Causes upper dermal edema with blockage of the superficial lymphatics, causing the clinical orange peel or peau dorange appearance of the affected skin and localized lymphadenopathy
  • May be accompanied by constitutional symptoms of fever, chills, malaise
  • Preexisting lymphedema is a known risk factor (Acta Dermatovenerol Alp Panonica Adriat 2009;18:63)

  • Rare complications include:
    • Infective endocarditis or septic arthritis with septicemia
    • Post-streptococcal glomerulonephritis in children
    • Facial erysipelas can cause cavernous sinus thrombosis
    • Streptococcal toxic shock syndrome
Treatment
  • IV and PO penicillin
  • Erythromycin can be used in those with penicillin allergies
  • Treatment requires 10 - 14 days of antibiotics; no scarring occurs
  • Prognosis is excellent with appropriate antibiotic therapy; however, local recurrence has been reported in up to 20% of patients with predisposing conditions
  • Recurrent erysipelas is treated with local antiseptics, general wound care and long term management of lymphedema (Neth J Med 2007;65:89)
  • Currently, there are no guidelines for long-term antibiotics; one regimen is 2.4 MU benzathin-penicillin G IM every 2 weeks, for up to 2 years (J Eur Acad Dermatol Venereol 2006;20:818)
Clinical Images

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Various images

Micro Description
  • Marked dermal edema, vascular dilatation and streptococcal invasion of lymphatics and tissues
  • The dermal inflammatory infiltrate consist of neutrophils and mononuclear cells
Additional References