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]

  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]

  The symptoms include severe pain, swelling, and inflammation, often accompanied by fever, rigours, nausea, and feeling generally unwell. [cochrane.org]

  Also pain and redness would visibly get reduced with frequent use of this home remedy. 4. Wormwood Tea Wormwood tea is amazing and when it comes to erysipelas, it works wonders on the infection. [homeremedyfind.com]

  Any pain, swelling, or discomfort can be treated with rest, a cold compress, and elevation of the affected limb. Nonsteroidal anti-inflammatory drugs like Advil (ibuprofen) or Aleve (naproxen) can be used to relieve pain and fever. [verywellhealth.com]

• Chills

  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]

  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]

  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]

  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]

• Gangrene

  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]

  The rapidly developing necrosis and ulceration within two weeks before admission could be due to necrotizing fascitis when gangrene tends to follow in multiple sites. [hindawi.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.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]

  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]

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

• Pneumonia

  Streptococcus pneumoniae produced an erysipelas-like eruption in a patient with the nephrotic syndrome. The eruption and accompanying fever resolved upon treatment with aqueous penicillin. [ncbi.nlm.nih.gov]

  Pathology Most commonly caused by Group A streptococci but can also be caused by S. aureus, K. pneumoniae and H. influenzae spp. 1,2. Promoted articles (advertising) [radiopaedia.org]

  However, other causes have been reported, including Staphylococcus aureus (including methicillin-resistant S. aureus [MRSA]), Klebsiella pneumoniae, Haemophilus influenzae, Escherichia coli, Staphylococcus warneri, Streptococcus pneumoniae, Streptococcus [merckmanuals.com]

  Mycoplasma pneumonia Another cause of erythema multiforme is mycoplasma pneumonia, a contagious respiratory infection with Mycoplasma pneumoniae bacteria. [medicalnewstoday.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]

• 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]

• Erythema

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

  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]

  Footnotes Ref Notes 1 The erythema will regress if the treatment is effective. [medicalguidelines.msf.org]

• 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]

• Skin Lesion

  The unusual presentation with absence of erythema in the skin lesion is emphasized. Atypical fever patterns were also noted. [ncbi.nlm.nih.gov]

  Erysipelas occurs when bacteria invade the epidermis as a consequence of skin lesions. [symptoma.com]

  Migrating erysipelas Migrating erysipelas, as its name suggests, is characterized by expanding skin lesions, followed by temperature. [en.dermatim.net]

  If you have a specific question or concern about a skin lesion or disease, please consult a dermatologist. [aocd.org]

• Dermatitis

  (1) Stasis Dermatitis (6) Sweet's Syndrome (65) Systemic Lupus Erythematosus (33) Thrombophlebitis (5) Zoster Ophthalmicus (2) related links Search www.google.com for 'Erysipelas' Medizinische Algorithmen [dermis.net]

  BACKGROUND: Orthopaedic implants are known to rarely induce or exacerbate dermatitis in metal-allergic patients. In the late 1990s, hypersensitivity to prosthetic material has been suspected to induce recurrent aseptic localized cellulitis. [ncbi.nlm.nih.gov]

  The differential diagnosis of cellulitis of the legs includes allergic contact dermatitis, deep venous thrombosis, and stasis dermatitis. Allergic contact dermatitis and stasis dermatitis tend to be bilateral. [consultant360.com]

  […] phlebitis, radiotherapy, mastectomy, lymphadenectomy) Alcohol abuse Morbid obesity Recent streptococcal pharyngitis Varicella General Prevention Good skin hygiene It is recommended that predisposing medical conditions, such as tinea pedis and stasis dermatitis [unboundmedicine.com]

• Angioedema

  […] bullae occasionally develop on the surface The lesion does not usually become pustular or gangrenous and heals without scar formation Deep venous thrombosis Venous stasis Candidiasis Anthrax Contact dermatitis Herpes zoster (shingles) Scarlet fever Angioedema [accessmedicine.mhmedical.com]

  Erysipelas must be differentiated from herpes zoster, angioedema, contact dermatitis, and diffuse inflammatory carcinoma of the breast. [microbe-canvas.com]

  Erysipelas of the face must be differentiated from herpes zoster, angioedema, and contact dermatitis. Diffuse inflammatory carcinoma of the breast may also be mistaken for erysipelas. [merckmanuals.com]

  To make a definitive diagnosis of erysipelas, a doctor often needs to exclude other possible causes such as: Cellulitis Skin allergies, including insect bites Angioedema Contact dermatitis Herpes zoster (shingles) Drug allergy Stevens-Johnson syndrome [verywellhealth.com]

  Erysipelas must be differentiated from herpes zoster, angioedema, contact dermatitis, erythema chronicum migrans of early Lyme disease, gout, septic arthritis, septic bursitis, vasculitis, allergic reaction to an insect bite, acute drug reaction, deep [en.wikipedia.org]

• Suggestibility

  Suggestive linkage (NPL(all)>3.0) was found at three loci: 3q22-24, 21q22, and 22q13. [ncbi.nlm.nih.gov]

  A predisposing factor for stasis dermatitis is venous incompetency, which may be suggested by a lack of hair on the shins. [consultant360.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]

  Signs and Symptoms: Facial erysipelas Pharyngitis may precede rash by several days Focal area on face of Paresthesia or pain Rash develops in area of sensory change Rash develops as described in signs (see above) May appear similar to SLE butterfly Malar [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]

• Headache

  […] have also been proposed by the International Headache Society. [radiopaedia.org]

  The differential diagnoses are primary angiitis of the central nervous system, aneurysmal subarachnoid haemorrhage and other causes of thunderclap headaches. [svemedplus.kib.ki.se]

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

  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]

  […] 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]

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).

• Staphylococcus Aureus

  Given the emergence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) over the past decade the proportion of infections due to S. aureus has become particularly relevant. [ncbi.nlm.nih.gov]

  Staphylococcus aureus was isolated from 7 (50%), while S. warneri, Streptococcus pyogenes and Escherichia coli grew from the lesions of 3 other patients. [doi.org]

  However, it can also be caused by other bacteria such as Staphylococcus aureus, including a strain of Staphylococcus called methicillin-resistant Staphylococcus aureus (MRSA). Erysipelas occurs most frequently on the legs and face. [msdmanuals.com]

No patient stopped the treatment because of side-effects. No predictive factor of erysipelas recurrence under antibiotic prophylactic treatment was identified. [ncbi.nlm.nih.gov]

Treatment of Erysipelas The treatment for erysipelas include: Oral antibiotics Intravenous antibiotics for hospitalized patients [healthinplainenglish.com]

It has favourable prognosis, and rarely develops any complication with timely and appropriate therapy. [ncbi.nlm.nih.gov]

Prognosis With prompt treatment, the prognosis from erysipelas is excellent. Delay of treatment, however, increases the chance for bacteremia and the potential for death from overwhelming sepsis. [encyclopedia.com]

Prognosis for Erysipelas With proper treatment, the prognosis of Erysipelas is very good. With antibiotics, erysipelas can resolve within a week. It takes another week for the skin to return to its normal state and the skin may also peel. [epainassist.com]

The infection's predictable response to penicillin, even when S aureus is present, argues against S aureus as an etiologic agent. [emedicine.com]

The most frequently involved bacterial agent is group A Streptococcus, which is also an etiologic agent of erysipelas. We present the case of a man aged 46 years with left-leg erysipelas who developed myocarditis. [ncbi.nlm.nih.gov]

Seventy patients were identified and their medical records were retrospectively reviewed so as to record the epidemiological and clinical data. [ncbi.nlm.nih.gov]

Two cases of facial lymphangitis have been described, and the pathophysiology of erysipelas has been discussed. [ncbi.nlm.nih.gov]

Pathophysiology and Etiology Pathophysiology In erysipelas, the infection rapidly invades and spreads through the lymphatic vessels. This can produce overlying skin "streaking" and regional lymph node swelling and tenderness. [emedicine.com]

Despite their burden of morbidity, the evidence for different prevention strategies is unclear. [cochrane.org]

You can also use moisturiser on the affected area to help the skin heal and to prevent it drying out. If you have repeated occurrences of erysipelas, then you may require long term antibiotic treatment to help prevent it returning in the future. [pushdoctor.co.uk]

Can Staph Infections Be Prevented? A couple of recent outbreaks among football players began when one team member had a boil and the infection was spread to other team members. You can take steps to help prevent staph infections. [webmd.com]

OBJECTIVES: To assess whether prophylactic antibiotics prescribed after an episode of cellulitis of the leg can prevent further episodes. [ncbi.nlm.nih.gov]

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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.