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Erysipelas is an infection of the upper layers of the skin (superficial). The most common cause is group A streptococcal bacteria, especially Streptococcus pyogenes. Erysipelas results in a fiery red rash with raised edges that can easily be distinguished from the skin around it. The affected skin may be warm to the touch. At one time, erysipelas was thought to affect mostly the face, but recent studies suggest that the distribution of the inflammation is changing since at the present time the legs are involved in almost 80% of cases. The rash may also appear on the arms or trunk.
Erysipelas begins with minor trauma, such as a bruise, burn, wound, or incision. When the rash appears on the trunk, arms, or legs, it is usually at the site of a surgical incision or a wound.
Erysipelas usually first appears as a localized lesion that is tender and red. The lesion quickly develops a bright red, shiny color and a spreading, raised border. The typical lesion is so characteristic that its presence is diagnostic. The lesion may feel hot and be painful. There may be accompanying high fever, chills, headache, nausea, and a general feeling of ill health (malaise). The skin in the affected area may resemble the peel of an orange.
In infants, erysipelas may appear on the abdomen due to infection of the umbilical cord. In children and adults, erysipelas most commonly develops on the legs, arms and face. Erysipelas may also develop at sites of minor surgery or trauma, or it may be due to lymphatic obstruction.
Erysipelas is caused by one of several strains of streptococcus bacteria, or less frequently by a staphylococcus infection. Streptococci are involved in about 80% of cases.
Erysipelas is a fairly common infection that may affect anyone at any age. It is most common in infants, young children and the elderly, including adults of either sex between ages 60 and 80.
Symptoms of the following disorders can be similar to those of erysipelas. Comparisons may be useful for a differential diagnosis:
Orbital cellulitus is a bacterial infection characterized by inflammation of the tissue surrounding the eye. Symptoms may include pain in the eye socket, abnormal protrusion of the eyeball, impaired movement of the eye, swelling of the eyelid and fever.
Herpes zoster is a viral infection of the central nervous system. It is characterized by the eruption of blisters, nerve pain and severe itching of the skin. The involved skin is usually very sensitive and painful. (For more information on this disorder, choose "Herpes Zoster" as your search term in the Rare Disease Database.)
Contact dermatitis is a common acute or chronic skin inflammation triggered by substances that one is allergic to which come in contact with the skin. It is characterized by red, itching, oozing, crusting, scaling, burning and painful skin. (For more information on this disorder, choose "Contact Dermatitis" as your search term in the Rare Disease Database.)
Dermatolymphangioadenitis (DLA) is a disorder characterized by redness of the skin. Symptoms may include malaise, fever, and chills. DLA most often occurs after surgery, trauma, or dermatitis types of lymphedema. Studies have suggested that periodic low doses of Benzathine penicillin may be effective in preventing recurrences of DLA.
The typical erysipelas lesion is so characteristic that its presence is diagnostic.
The treatment of choice is penicillin. For the penicillin-allergic patient, erythromycin or cephalexin may be used.
Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.
For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:
Tollfree: (800) 411-1222
TTY: (866) 411-1010
For information about clinical trials sponsored by private sources, contact:
The French Erysipelas Study Group, headquartered at a major teaching hospital in Reims, France, reported recently the results of a multi-center, randomized, controlled, clinical trial of a new treatment for erysipelas involving the drug pristinamycin. The group is studying whether pristinamycin might replace oral penicillin as the drug of choice to treat this disorder.
The results of these trials are being debated among clinical researchers interested in the treatment of this disorder.
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Berkow R, ed. The Merck Manual-Home Edition.2nd ed. Whitehouse Station, NJ: Merck Research Laboratories; 2003:1221.
Champion RH, Burton JL, Ebling FJG. eds. Textbook of Dermatology. 5th ed. Blackwell Scientific Publications. London, UK; 1992:968-72.
Bonnetblanc JM, Bedane C. Erysipela: recognition and management. Am J Clin Dermatol. 2003;4:157-63.
Stulberg DL, Penrod MA, Blatny RA. Common bacterial skin infections. Am Fam Physician. 2002;66:119-24.
Laube S, Farrell AM. Bacterial skin infections in the elderly: diagnosis and treatment. Drugs Aging. 2002;19:331-42.
Bernard P, Chosidow O, Vaillant L French Erysipelas Group. Oral pristinamycin versus standard penicillin regimen to treat erysipelas in adults: randomised, non-inferiority, open trial. BMJ. 2002;325:864.
FROM THE INTERNET
Kotton C. Erysipelas. Medical Encyclopedia. MEDLINEplus. Update Date: 7/19/2002. 2pp.
Stanway A. Erysipelas. New Zealand Dermatological Society. Last Updated: 24 April 2002. 2pp.
Davis l, Benbenisty K. Erysipelas. emedicine. Last Updated: February 25, 2003. 9pp.
Morgan JA. Erysipelas. Emergency Medicine Bulletin Board System (EMBBS). nd. 3pp.
Moses S. Family Practice Notebook. Last revised 9/6/2003. 4pp.
NIAID. Health Matters. Group A Streptococcal Infections. August 2002. 6pp.
Report last updated: 2009/05/11 00:00:00 GMT+0