eMedicine Specialties > Emergency Medicine > Infectious Diseases

Erysipelas

Author: Geofrey Nochimson, MD, Consulting Staff, Department of Emergency Medicine, Sentara Careplex Hospital
Contributor Information and Disclosures

Updated: Nov 25, 2009

Introduction

Background

Erysipelas is a skin infection typically caused by group A beta-hemolytic streptococci, although other streptococcal groups are occasionally causative agents. Infection involves the dermis and lymphatics and is a more superficial subcutaneous infection of the skin than cellulitis. Erysipelas is characterized by intense erythema, induration, and a sharply demarcated border, which differentiates it from other skin infections.1

Pathophysiology

The skin is the primary organ system affected.

Frequency

United States

Increasing incidence has been noted since the late 1980s.

Mortality/Morbidity

Erysipelas generally is benign; however, it can be fatal when associated with bacteremia in very young, elderly, or immunocompromised patients. The mortality rate is less than 1% in treated cases.

Sex

Slight female predominance is observed.

Age

Infection occurs at extremes of age, but erysipelas is primarily a disease of adults.

Clinical

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.

Physical

  • The patient may appear healthy or toxic depending on the extent of infection.
  • Fever is common.
  • Dermatologic signs
    • 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 patients2

    • Facial erysipelas exhibiting classic fiery-red pl...

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

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      Facial erysipelas exhibiting classic fiery-red pl...

      Facial 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

Causes

  • Group A streptococci are the most common cause.3 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
    • 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

More on Erysipelas

Overview: Erysipelas
Differential Diagnoses & Workup: Erysipelas
Treatment & Medication: Erysipelas
Follow-up: Erysipelas
Multimedia: Erysipelas
References
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References

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

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

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

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

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

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

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

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

  9. 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].

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

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

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

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

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Further Reading

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Keywords

erysipelas, erysipelas causes, erysipelas treatment, erysipelas symptoms, cellulitis, group A beta-hemolytic streptococci, hemolytic streptococcus, skin infection, painful rash, erythematous rash

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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.

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Eddy Lang, MDCM, CCFP (EM), CSPQ, Assistant Professor, Department of Family Medicine, McGill University; Consulting Staff, Department of Emergency Medicine, The Sir Mortimer B Davis-Jewish General Hospital
Eddy Lang, MDCM, CCFP (EM), CSPQ is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

CME Editor

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, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
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

 
 
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