Erysipelas occurs when bacteria invade the epidermis as a consequence of skin lesions. Patients with eczema or patients who engage in strong physical activities as well as patients with a weakened or systemically impaired immune system are at an increased risk of developing erysipelas. Children younger than six and seniors older than sixty are mostly affected by erysipelas. Furthermore, patients with a history of drug use also face an increased erysipelas risk because of regular injections. Possible other causes for erysipelas include skin ulcers, surgical incisions, insect bites, psoriasis, and edema feet secondary to cardiac insufficiency and diabetes [1] [2].

Erysipelas has been shown to be caused by an infection with the following bacteria: group A / C / D streptococci, Klebsiella pneumonia, Haemophilus influenza, Escherichia coli, and Moraxella. Notably, methicillin-resistant Staphylococcus aureus has also been found in the context of erysipelas [3] [4].

Typical symptoms of erysipelas are a large, elevated, painful erythematous skin patch with sharp borders, blisters, swollen glands, fever, chills and general malaise. Most facial infections are attributed to group A streptococci and usually affect both cheeks and the nose. Erysipelas can also occur after a throat infection with subsequent bacterial migration to the nasal passages [1].

The most common complications of erysipelas include abscess, gangrene, and thrombophlebitis. In selected cases, acute glomerulonephritis, endocarditis, septicemia, and streptococcal toxic shock syndrome may occur. Osteoarticular complications may present as bursitis, osteitis, arthritis, and tendinitis [5] [6].

• Fever

  Atypical fever patterns were also noted. In one patient, the facial lesion followed the onset of fever by 48 hours, and, in the other, the facial swelling preceded the fever. [ncbi.nlm.nih.gov]

• Pain

  The results suggest that group A streptococci induce contact activation and HBP release during skin infection, which likely contribute to the symptoms seen in erysipelas: fever, pain, erythema, and edema. [ncbi.nlm.nih.gov]

  Typical symptoms of erysipelas are a large, elevated, painful erythematous skin patch with sharp borders, blisters, swollen glands, fever, chills and general malaise. [symptoma.com]

  It is characterized by well demarcated areas of redness, heat, pain, and swelling and may be associated with constitution symptoms including fever, chills, headache, joint pain, and back pain. [aocd.org]

• Chills

  Fever with chills and general malaise may be prominent symptoms. Antibiotics are usually effective. Patients handled in a timely manner tend to recover without problems. [ncbi.nlm.nih.gov]

  Symptoms of Erysipelas The symptoms of erysipelas include: Sharply defined, bright red area of the skin Hot and painful area Slightly elevated as compared to the rest of the skin Sometimes a red streak extending to the lymph node can be noticed Fever and chills [healthinplainenglish.com]

  Symptoms of erysipelas may include: Fever and chills Skin sore with a sharp raised border. As the infection spreads, the skin is painful, very red, swollen, and warm. Blisters on the skin then form. [mountsinai.org]

  The onset is usually abrupt with high fever, chills, and weakness. Over the next 24- 48 hours a red shiny plaque forms usually proximal to the area of entry into the skin. [aocd.org]

• Gangrene

  The most common complications of erysipelas include abscess, gangrene, and thrombophlebitis. In selected cases, acute glomerulonephritis, endocarditis, septicemia, and streptococcal toxic shock syndrome may occur. [symptoma.com]

  Definitions of erysipelas 1 n an acute streptococcal infection characterized by deep-red inflammation of the skin and mucous membranes Type of: Saint Anthony's fire any of several inflammatory or gangrenous skin conditions [vocabulary.com]

  Complications of erysipelas may include the following: Gangrene/amputation Chronic edema Scarring Bacteremia sepsis Scarlet fever Pneumonia Abscess [1, 11] Embolism Meningitis Death The most common complications of erysipelas include abscess, gangrene [emedicine.medscape.com]

• Malaise

  Fever with chills and general malaise may be prominent symptoms. Antibiotics are usually effective. Patients handled in a timely manner tend to recover without problems. [ncbi.nlm.nih.gov]

  High fever, chills, and malaise frequently accompany erysipelas. There is also a bullous form of erysipelas. [merckmanuals.com]

  Clinical features Well-defined, indurated, raised and shiny plaques associated with fevers and general malaise most commonly around the lower limbs and face. Erysipelas can recur and can be complicated by abscess formation or thrombophlebitis. [radiopaedia.org]

  Typical symptoms of erysipelas are a large, elevated, painful erythematous skin patch with sharp borders, blisters, swollen glands, fever, chills and general malaise. [symptoma.com]

• Tachycardia

  Examination findings included resting tachycardia and melenic stool. Blood pressure was 95/50 mm Hg. Multiple raised, soft, bluish 0.3 to 1 cm lesions were noted on the trunk and extremities. [consultant360.com]

  Up to 25% of patients will die from the disease The following cases of cellulitis: Associated with marked systemic upset eg fever, vomiting, tachycardia, hypotension Spreading cellulitis that is not responding to oral medication Lymphangitis Have a lower [pcds.org.uk]

  Statistically significant differences (P 0.05) were seen between 20 controls with erysipelas but without lymphedema and 10 age- and sex-matched patients with lymphedema hospitalized for erysipelas: prolonged persistence of fever, more frequent tachycardia [phlebolymphology.org]

• Erythema

  All had a painful erythema of the medial part of one or both calves and all failed numerous antibiotic regimens. In all patients a sharply demarcated, tender indurated erythema of the medial part of one or both calves was seen. [ncbi.nlm.nih.gov]

  His edema and erythema resolved with no recurrence; graduated compression stockings were prescribed. [cmaj.ca]

  When erythematous erysipelas affected skin is characterized by redness (erythema), swelling and soreness. Erythema has a uniformly bright color, clear boundaries, a tendency to peripheral distribution and rises above the skin. [medusanews.com]

• Eczema

  Many patients with gravitational eczema are incorrectly diagnosed of having bilateral cellulitis, which is extremely rare, and are inappropriately given systemic antibiotics over several months Patients with gravitational eczema will have itch, non-tender [pcds.org.uk]

  Other medical conditions which cause any breakage of the skin, such as eczema or athlete's foot, can also lead to erysipelas. Conditions which prevent any fluid or blood draining from a region also increase the risk of erysipelas. [epainassist.com]

• Flushing

  Baking Soda Remedy Baking soda is widely used for deep cleansing the skin and for erysipelas you can use this remedy which would flush out all the bacteria and get you a clean skin without infections and disorders. [homeremedyfind.com]

  Both erysipelas and cellulitis present clinically as a skin infection, that is, flushing (redness), local heat, intense pain and edema (swelling) in the affected area. [uncanxietyclinic.com]

  rosarium, redness noun فورة fawra outburst, flush, gust noun, verb تهيج tahij irritation, agitation, excitement, go red noun, verb توهج tawhaj glow, flare, flamboyance, radiance, flush noun القساوة alqasawa hardness, rawness الآلام alalam pain Watch [wordhippo.com]

  You may get a bright strawberry-red tongue and flushed (rosy) face, while the area around your mouth remains pale. The skin on the tips of your fingers and toes often peels after you get better. [medicinenet.com]

• Eye Swelling

  Some patients have swelling of the eyelids, sometimes so severe that their eyes swell shut. The patient may have fever, chills, loss of energy, nausea and vomiting, and swollen, tender lymph nodes. [encyclopedia.com]

• Malar Rash

  Malar rash occurs in many local and systemic illnesses. More common causes of malar rash include erysipelas, cellulitis, systemic lupus erythematosus, and rosacea. [amjmed.com]

  Rash Edema may develop of eyes and cheeks XI. [fpnotebook.com]

  rash of systemic lupus erythematous, photodermatis, rosacia, Melkersson - Rosenthal syndrome, Sweet's syndrome, dermatomyositis and relapsing polychondritis., Although all ages are affected, erysipelas primarily is a disease of adults with a peak age [lymphedemapeople.com]

• Cellulitis of the Face

  The anatomic diagnosis was erysipelas with acute cellulitis of the face, neck, and chest; acute mediastinitis involving the pericardium and pleurae with pleural effusion; and acute congestion of the viscera. [jamanetwork.com]

• Facial Swelling

  In one patient, the facial lesion followed the onset of fever by 48 hours, and, in the other, the facial swelling preceded the fever. Various aspects of the patient's altered host status are discussed in light of the atypical clinical presentation. [ncbi.nlm.nih.gov]

• Incontinence

  The occurrence of erysipelas is usually associated with lymphatic edema or venous incontinence. Lymphatic lesions due to radiotherapy or surgery may afflict draining vessels leading to venous and lymphatic stasis and then infection occurs. [ncbi.nlm.nih.gov]

• Headache

  Also, at the same time general malaise, headache, sickness and an urge to vomit are present. [en.dermatim.net]

  […] compare Latin pellis skin) Latin erysipelas 1350–1400; Middle English erisipila Collins Concise English Dictionary HarperCollins Publishers:: erysipelas / ˌɛrɪˈsɪpɪləs / n an acute streptococcal infectious disease of the skin, characterized by fever, headache [wordreference.com]

  It is characterized by well demarcated areas of redness, heat, pain, and swelling and may be associated with constitution symptoms including fever, chills, headache, joint pain, and back pain. [aocd.org]

Classical erysipelas usually does not require elaborate diagnostic workup. However, it is important to distinguish erysipelas from a symptomatically similar type of cellulitis, which does not present with sharp borders with inflammation.

Erysipelas diagnosis is based on a clinical examination of the affected area and an analysis of the patient history. In selected cases, routine blood analysis may be ordered, which commonly reveals an increased erythrocyte sedimentation rate and C-reactive proteins. Standard imaging techniques are usually not necessary for the diagnosis [1] [7].

Bacterial cultures extracted from the infected tissue rarely yield satisfying results. Histological characteristics are dermal edema, vascular dilatation and streptococcal invasion of lymphatics and tissues resulting in an increased presence of neutrophils and mononuclear cells. Bacteria may also infiltrate proximal blood vessels [1].

Erysipelas symptoms can be efficiently countered with cold compresses on the affected skin area, sufficient water intake and fever-reducing measures as well as painkillers.

Surgical removal of erysipelas may be necessary if the infection has led to tissue necrosis. Recurrent erysipelas may occur in around 20% of the patients [8] with potentially disabling disfigurements (e.g. elephantiasis nostras verrucosa).

1. Bonnetblanc JM, Bedane C. Erysipelas: recognition and management. Am J Clin Dermatol. 2003; 4(3):157-163.
2. Bernard P. Management of common bacterial infections of the skin. Curr Opin Infect Dis. 2008; 21(2):122-128.
3. Matz H, Orion E, Wolf R. Bacterial infections: uncommon presentations. Clin Dermatol. 2005; 23(5):503-508.
4. Krasagakis K, Samonis G, Maniatakis P, Georgala S, Tosca A. Bullous erysipelas: clinical presentation, staphylococcal involvement and methicillin resistance. Dermatology. 2006; 212(1):31-35.
5. Gunderson CG, Chang JJ. Risk of deep vein thrombosis in patients with cellulitis and erysipelas: a systematic review and meta-analysis. Thromb Res. 2013; 132(3):336-340.
6. Coste N, Perceau G, Leone J, et al. Osteoarticular complications of erysipelas. J Am Acad Dermatol. 2004; 50(2):203-209.
7. Grosshans EM. The red face: erysipelas. Clin Dermatol. 1993; 11(2):307-313.
8. Eriksson BKG. Anal Colonization of Group G β-Hemolytic Streptococci in Relapsing Erysipelas of the Lower Extremity. Clin Infect Dis. 1999; 29(5): 1319-1320.