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Erysipelas - Causes, Symptoms and Treatment

What is Erysipelas?

Erysipelas is a skin infection, caused by Group A streptococci, involving the dermis and lymphatics. It's a more superficial subcutaneous infection of the skin than cellulitis. The affected area is well demarcated, erythematous, edematous, indurated, and warm. Often very painful, erysipelas commonly occurs on the face, lower extremities, and in areas of pre-existing edema. Without prompt treatment erysipelas can be life-threatening due to the spread of the infection; treatment usually controls the disease within 1 week.

What are the Causes of Erysipelas?

Group A beta-hemolytic streptococci are the most common cause of erysipelas. It may also be caused by group B, C. and G streptococci and, rarely, staphylococci. The microbes enter the skin through a wound such as abrasions, trauma, insect bites, and skin ulcers.

What are the Signs and Symptoms of Erysipelas?

This disease is marked by abrupt onset of fever, chills, and bright red skin rash with sharp, distinct borders, usually appearing on the face, arms or legs. The affected area may feel warm or hot to the touch. The rash may spread or enlarge noticeably and blisters may develop. The patient may also complain of joint stiffness, muscle aches, headache, nausea, vomiting and loss of appetite, and malaise.

Diagnosis for Erysipelas

Diagnosis is based on clinical findings. The causative microbe is difficult to culture from the rash but may be cultured from blood in 5% of cases. The white blood cell count is increased with a leftward shift and erythrocyte sedimentation rate may be elevated. The diagnosis should rule out early stages of contact dermatitis, giant urticaria, and prevesicular herpes zoster.

Treatment for Erysipelas

Depending on the severity, treatment involves either oral or I.V. antibiotics - usually penicillin or erythromycin. Analgesics and antipyretics are given for pain and fever. Non-drug treatments include rest and immobilization and elevation of the affected area. Warm, moist compresses increase circulation in the area and promote healing.

Special Considerations and Prevention Tips for Erysipelas

  • Remind the patient to finish the full course of antibiotics even if symptoms abate.
  • Encourage the patient to rest and elevate the affected area.
  • Be aware of allergies to antibiotics.
  • Instruct the patient about good skin hygiene and avoidance of skin traumas. Encourage the patient to report any skin changes to the doctor.

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