bubble_chart Overview

Erysipelas is an acute inflammation characterized by widespread redness and swelling caused by beta-hemolytic streptococci. The affected area may develop blisters or bullae, and in severe cases, gangrene can occur. Patients may experience systemic symptoms such as fever.

bubble_chart Etiology

The causative agent of erysipelas is beta-hemolytic streptococcus. Tinea pedis, leg ulcers, and trauma are common predisposing factors for erysipelas of the leg; microscopic fissures in the nasal cavity, external auditory canal, or below the ear, which are not visible to the naked eye, often serve as predisposing factors for facial erysipelas.

bubble_chart Clinical Manifestations

After an incubation period of approximately 2 to 5 days, the disease suddenly and acutely manifests, accompanied by systemic symptoms such as high fever, shivering, headache, and vomiting. The initial rash is a burning red patch that rapidly spreads to form a red lesion. The area is red, hot, swollen, and tender to the touch. The surface is tense and shiny, with a distinct outline. In severe cases, blisters and bullae may develop, and even gangrene may occur, with the skin turning from red to dark red and bluish-black, followed by necrosis and shedding of skin tissue, exposing subcutaneous tissue; septicemia can lead to death within a short period. There is an increase in white blood cells in the blood, accelerated erythrocyte sedimentation rate, and elevated anti-streptolysin O. Recurrent erysipelas is a chronic form of erysipelas. It recurs at the site of the original lesion every few days, weeks, months, or even years. The symptoms of recurrence are milder than those of typical erysipelas, with slight redness and swelling of the affected area, grade I fever, and general malaise, often resolving naturally after a few days. The common sites for recurrent erysipelas are the lower limbs, followed by the face. After repeated episodes, the affected tissue often thickens, leading to chronic lymphedema. Although erysipelas can also occur in infants (umbilical infection), generally, the incidence is higher after adolescence, with several peaks between the ages of 20 and 60, and less frequent after the age of 70. Currently, there is no further evidence to support the occasional claim that elderly erysipelas presents with more exudative or even bullous lesions.

bubble_chart Auxiliary Examination

Histopathology reveals significant edema, vascular dilation, and the presence of numerous neutrophils, lymphocytes, and streptococci around the blood vessels. The endothelial cells lining the lymphatic vessels exhibit swelling, particularly in the eyelid.

bubble_chart Treatment Measures

Bed rest is required. Symptomatic treatment should be provided for fever, poisoning, and discomfort. Special attention should be paid to preventing bronchopneumonia, heart failure, and other complications in elderly patients. Concurrent treatment should be given for the underlying causes.

Penicillin is the first choice, administered intravenously at 4.8 to 8 million units per day. For those allergic to penicillin, erythromycin at 1 to 1.5 g/d intravenously or ciprofloxacin at 0.2 g per dose, twice daily intravenously, can be used. Oral ofloxacin at 0.2 g per dose, twice daily, is also an option. Alternatively, cefazolin at 6 g/d intravenously or other cephalosporin antibiotics can be used. Generally, a treatment course lasts 10 to 14 days, and treatment should be maintained for a period after the skin lesions subside. Sulfonamides can also be taken orally. For recurrent erysipelas, the duration of medication should be longer than for acute erysipelas, and medication should not be stopped too early to prevent recurrence and avoid the continuous development of lymphatic edema.

bubble_chart Differentiation

This disease must be differentiated from contact dermatitis, cellulitis, polymorphous light eruption, and angioneurotic edema.

1. Contact dermatitis has a history of contact. Local redness and swelling, unclear boundaries, and itching. The rash includes papules, vesicles, bullae, erosions, exudation, and crusting. The white blood cell count does not increase.

2. Cellulitis occurs in deeper layers, involving inflammation of the subcutaneous tissue. The affected area is tender and slightly red and swollen, with indistinct borders. The inflammation rapidly spreads and worsens, with the central inflammation being more pronounced. There is significant pitting edema, which later softens, ruptures, and suppurates, discharging pus and necrotic tissue.

3. Polymorphous light eruption is a polymorphous rash that occurs on the face and exposed areas. The lesions include erythema, telangiectasia, edematous erythema, maculopapules, papulovesicles, vesicles, or lichenification.

4. Angioneurotic edema is a transient, localized, painless subcutaneous or submucosal edema. It often occurs in areas with loose tissue that are prone to swelling, such as the eyelids, lips, earlobes, external genitalia, and larynx.