What is Erysipelas?
Erysipelas is a bacterial infection, which ordinarily involves the upper layers of the skin, while cellulitis affects the deeper layers and connective tissues. Erysipelas is also known as St. Anthony’s fire. In most cases, it is caused by Group A streptococcus strain of bacteria.
In the past decades, this type of infection was mainly observed on the face. Nowadays, it is seen most commonly on the lower legs.
A cluster of signs and symptoms of erysipelas typically precedes the appearance of the rash by 4-48 hours. Main symptoms include fever, fatigue, chills, anorexia and vomiting.
Typically, the rash appears as a painful bright red, hot, shiny, swollen patch that has clearly defined borders. Red streaks leading from the involved area may be a sign that the infection has started to spread along the lymphatic vessels.
Diagnosis relies mainly on the appearance of the rash, making skin biopsies and blood tests, unnecessary.
Erysipelas is treated with antibiotics; different antibiotics may be used, including dicloxacillin, penicillin, cephalosporin, erythromycin and clindamycin. Usually, oral treatment is enough to cure this type of skin infection. However, the recurrence of the infection is frequently observed. In clinical practice, about one-third of patients who have had erysipelas will get it again.
Cellulitis and Erysipelas
As mentioned earlier, cellulitis is a bacterial infection of the deep layers of skin and subcutaneous tissues. It also manifests with local symptoms; the patient’s skin is red, tender and painful to the touch in the affected area. Blisters, abscesses and swollen lymph nodes can also develop. General symptoms may include chills, fever and elevated white blood cell count.
Erysipelas can be considered as a form of cellulitis characterized by pronounced superficial inflammation. The term erysipelas is commonly used when the face is affected. The lower limbs are by far the most common sites affected by cellulitis and erysipelas, but any area, such as the ears, trunk, fingers, and toes, can be affected.
Erysipelas and cellulitis infection are more likely to arise if the surface of the skin is damaged with minor skin trauma (cuts, bruise, animal bites, etc.). A surgical wound improperly managed or during an operation, can also be a route for the penetration of bacteria, which are normally present at the surface of the skin.
Risks factors for erysipelas and cellulitis include skin diseases such as eczema, impetigo, fungal infections (athlete’s foot), psoriasis. The risk for skin infection is also higher if you have a weakened immune system due to certain medications like steroids, cancer drugs, or medications used following organ transplants to suppress the body’s immune response.
People with diabetes, venous insufficiency and/or who are overweight are also more prone to develop both cellulitis and erysipelas. It is important for people who have predisposing factors to skin infection, to maintain good hygiene, particularly, foot hygiene.
Erysipelas and cellulitis are both treated with antibiotics. The medication can be administered orally as tablets or into a vein using a drip if the case is severe.
It is also recommended to cool the swelling and apply moist antiseptic wraps. If the infection involves the leg, it can help to elevate that leg. In some cases when bed rest is required, the patient is prescribed a medication to prevent thrombosis.
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Last article update: 21/10/2019
Medically reviewed by Dr. Thouria Bensaoula on Sept 17, 2019.