Erysipelas is an acute inflammation of the skin and its reticular lymphatic vessels, caused by the invasion of β-hemolytic streptococci through minor wounds in the skin or mucous membranes. Erysipelas spreads rapidly but rarely leads to tissue necrosis or suppuration.

bubble_chart Clinical Manifestations

The common sites of erysipelas are the lower limbs and face. The onset is abrupt, and patients often experience headache, fear of cold, and fever. Local manifestations include patchy erythema with bright red color, lighter scaling, clearly defined edges, and slight elevation. Light finger pressure can cause the redness to fade, but it quickly returns after the pressure is removed. As the redness and swelling spread outward, the central area fades and desquamates, turning brownish-yellow. Blisters may sometimes form in the red and swollen area. There is a burning pain locally. Nearby lymph nodes are often swollen. Tinea pedis or filarial infection can cause recurrent episodes of erysipelas in the lower limbs, sometimes leading to lymphedema and even progressing to elephantiasis.

bubble_chart Diagnosis

1. The onset is acute, often accompanied by systemic symptoms such as fear of cold and fever, which may persist after the eruption.

2. It commonly occurs on the face and lower legs.

3. Skin lesions: The typical lesions are bright red, tender, burning, and well-demarcated indurated erythema. Blisters, bullae, pustules, or gangrene may develop in the swollen and red areas. Recurrent episodes may also occur at the primary lesion site (recurrent erysipelas).

4. In cases of multiple recurrences, prolonged lymphatic obstruction may lead to elephantiasis, most commonly seen in the lower legs.

6. The causative primary lesion is often identifiable, such as tinea pedis in the lower legs or nasal mucosal lesions on the face. {|105|}

bubble_chart Treatment Measures

Rest and elevate the affected area. Apply a 50% magnesium sulfate dampness-heat compress or use Qingfu ointment for external application. Systemic use of sulfonamides or penicillin is recommended, and treatment should continue for 3–5 days after the systemic and local symptoms disappear to prevent recurrence of erysipelas. For erysipelas of the lower limbs, if accompanied by tinea pedis, the tinea pedis should be treated to avoid recurrence of erysipelas. Additionally, precautions should be taken to prevent contact pestilence.

bubble_chart Differentiation

1. Contact dermatitis: There is a history of contact, accompanied by pain and itching but no tenderness, and no systemic symptoms.

2. Cellulitis: The redness and swelling have indistinct borders, with deep infiltration and obvious suppuration.

3. Angioedema: It commonly occurs in loose tissue areas, presenting as edematous lesions with indistinct margins and no tenderness.