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Erysipelas: A severe streptococcal bacterial infection where

infection spreads from the skin to tissue underneath. The face

and extremities are the usual sites affected. More detailed

information about thesymptoms,causes, andtreatmentsofErysipelas is available below.

Erysipelas - St. Anthony's FireFromHeather Brannon, MD, former About.com Guide

Updated January 08, 2005About.com Health's Disease and Condition content is reviewed bytheMedical Review Board

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Erysipelas is a superficial infection of the skin, which typically involves the

lymphatic system. Erysipelas is also known as St. Anthony's Fire, an accurate

description of the intensity of this rash. Erysipelas was a feared disease in

pre-antibiotic days, especially in infants.

Cause of Erysipelas

Erysipelas is most often caused by a specific Streptococcus bacteria known as

Group A Streptococcus. In a few cases, it can be caused by other types of

Streptococcus or Staphylococcus bacteria. Some cases of erysipelas have an

inciting wound such as trauma, an abrasion, or some other break in the skin

that precede the fiery infection. However, in most cases, no break in the skincan be found.

Appearance of Erysipelas

Erysipelas was previously found mainly on the face. However, now it is seen

most commonly on the lower extremities. Erysipelas tends to occur in areas

where the lymphatic system is obstructed. A cluster of symptoms typically

precede the appearance of the rash by 4 to 48 hours. These symptoms includefever, chills, fatigue, anorexia, and vomiting. The rash then quickly appears

as a bright red, hot, swollen, shiny patch that has clearly defined borders. The

consistency of the rash is similar to an orange peel, also known as "peau

d'orange".

Picture of erysipelas on the cheek

Picture of erysipelas on the face

Diagnosis of Erysipelas

Erysipelas is diagnosed mainly by the appearance of the rash. Blood tests and

skin biopsies generally do not help make the diagnosis. In the past, saline

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solution was injected into the edge of the rash, aspirated back out, and

cultured for bacteria. This method of diagnosis is not used anymore because

bacteria were not found in the majority of cases. If the preceding symptoms

such as fever and fatigue are significant enough, sometimes blood is drawnand cultured for bacteria to rule out sepsis.

Treatment of Erysipelas

Erysipelas is treated with antibiotics. A variety of antibiotics can be used

including penicillin, dicloxacillin, cephalosporins, clindamycin, and

erythromycin. Most cases of erysipelas can be treated with oral antibiotics.

However, cases of sepsis, or infections that do not improve with oralantibiotics require IV antibiotics administered in the hospital.

Recurrence of Erysipelas

Even after appropriate treatment with antibiotics, erysipelas can recur in 18%

to 30% of cases. People who are susceptible to recurrence are those with

compromised immune systems or compromised lymphatic systems. Because

erysipelas can damage the lymphatic system, the infection itself can be asetup for recurrence. Some people with recurrent infections must be treated

daily with low-dose antibiotics as a prevention of further infections.