Erysipelas in Emergency Medicine Clinical Presentation

  • Author: Geofrey Nochimson, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Apr 14, 2011
 

History

Erysipelas is a febrile illness with dermatological findings, characterized by an abrupt onset of illness with initial fever and chills followed by a painful rash occurring 1-2 days later.

Muscle and joint pain may accompany illness.

Nausea may be present.

Headache and other systemic manifestations of an infectious process may occur.

Skin discomfort is noted.

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Physical

The patient may appear healthy or toxic depending on the extent of infection.

Fever is common.

Dermatologic signs include the following:

  • Painful, erythematous, and edematous rash
  • Sharply-raised border with abrupt demarcation from healthy adjacent skin
  • Condition found in lower extremities in 70-80% of patients; face, as in the image below, affected in 5-20% of patients[3] Facial erysipelas exhibiting classic fiery-red plaFacial erysipelas exhibiting classic fiery-red plaque with raised, well-demarcated borders.

Erythema is irregular with extensions that may follow lymphatic channels (lymphangitis).

  • Desquamation
  • Vesicles
  • Lymphadenopathy
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Causes

Group A streptococci are the most common cause.[4] Less common etiologies include group G, C, and B streptococci and, rarely, staphylococci.

A defect in skin barrier allows the infection to occur. Infection may occur after trauma, abrasions, skin ulcers, insect bites, eczema, and psoriatic lesions.

Other predisposing factors include the following:

  • Lymphatic obstruction or edema
  • Saphenous vein grafting in lower extremities
  • Status postradical mastectomy
  • Immunocompromised patients, including patients who are diabetic or alcoholic
  • Arteriovenous insufficiency
  • Paretic limbs
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Contributor Information and Disclosures
Author

Geofrey Nochimson, MD  Consulting Staff, Department of Emergency Medicine, Sentara Careplex Hospital

Geofrey Nochimson, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Francis Counselman, MD  Program Director, Chair, Professor, Department of Emergency Medicine, Eastern Virginia Medical School

Francis Counselman, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Association of Academic Chairs of Emergency Medicine (AACEM), Norfolk Academy of Medicine, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Eddy S Lang, MDCM, CCFP(EM), CSPQ  Associate Professor, Senior Researcher, Division of Emergency Medicine, Department of Family Medicine, University of Calgary; Assistant Professor, Department of Family Medicine, McGill University

Eddy S Lang, MDCM, CCFP(EM), CSPQ is a member of the following medical societies: American College of Emergency Physicians, Canadian Association of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD 

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

  1. Bonnetblanc JM, Bedane C. Erysipelas: recognition and management. Am J Clin Dermatol. 2003;4(3):157-63. [Medline].

  2. Pereira de Godoy JM, Galacini Massari P, Yoshino Rosinha M, et al. Epidemiological data and comorbidities of 428 patients hospitalized with erysipelas. Angiology. Jul 2010;61(5):492-4. [Medline].

  3. Morris AD. Cellulitis and erysipelas. Clin Evid (Online). Jan 2 2008;2008:[Medline].

  4. Bernard P. Management of common bacterial infections of the skin. Curr Opin Infect Dis. Apr 2008;21(2):122-8. [Medline].

  5. Bisno AL, Stevens DL. Streptococcal infections of skin and soft tissues. N Engl J Med. Jan 25 1996;334(4):240-5. [Medline].

  6. Bratton RL, Nesse RE. St. Anthony's Fire: diagnosis and management of erysipelas. Am Fam Physician. Feb 1 1995;51(2):401-4. [Medline].

  7. Chartier C, Grosshans E. Erysipelas. Int J Dermatol. Sep 1990;29(7):459-67. [Medline].

  8. Elston DM. Epidemiology and prevention of skin and soft tissue infections. Cutis. May 2004;73(5 Suppl):3-7. [Medline].

  9. Jorup-Ronstrom C, Britton S. Recurrent erysipelas: predisposing factors and costs of prophylaxis. Infection. Mar-Apr 1987;15(2):105-6. [Medline].

  10. Krasagakis K, Samonis G, Maniatakis P, Georgala S, Tosca A. Bullous erysipelas: clinical presentation, staphylococcal involvement and methicillin resistance. Dermatology. 2006;212(1):31-5. [Medline].

  11. Krasagakis K, Valachis A, Maniatakis P, et al. Analysis of epidemiology, clinical features and management of erysipelas. Int J Dermatol. Sep 2010;49(9):1012-7. [Medline].

  12. Lopez FA, Lartchenko S. Skin and soft tissue infections. Infect Dis Clin North Am. Dec 2006;20(4):759-72, v-vi. [Medline].

  13. Morris A. Cellulitis and erysipelas. Clin Evid. Jun 2006;2207-11. [Medline].

  14. Pereira de Godoy JM, Galacini Massari P, Yoshino Rosinha M, et al. Epidemiological data and comorbidities of 428 patients hospitalized with erysipelas. Angiology. Jul 2010;61(5):492-4. [Medline].

  15. Swartz MN. Erysipelas. In: Mandell GL, ed, et al. Principles and Practice of Infectious Diseases. 4th ed. Churchill Livingstone; 1995:913-14.

  16. Torok L. Uncommon manifestations of erysipelas. Clin Dermatol. Sep-Oct 2005;23(5):515-8. [Medline].

 
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Facial erysipelas exhibiting classic fiery-red plaque with raised, well-demarcated borders.
 
 
 
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