Definition of erysipelas
"Erysipelas" is a term extracted from the medical language that identifies an acute infection of the skin, with evident involvement of the dermis, the superficial layers of the hypodermis and the lymphatic vessels: the erysipelas is generated by a bacterial infiltration responsible for progressive maceration of the skin, in turn favored by micro-lesions in the skin.
Incidence
Causes
Many studies have been carried out to find out what the main cause was: beta-hemolytic streptococci seem to be responsible for erysipelas, but other bacterial strains implicated in the disease have also been isolated. In fact, it seems that Streptococcus piogene, staphylococci, staphylococci of groups B, C and G, and other gram-negative bacteria contribute to the formation of infectious bubbles, sometimes of a haemorrhagic nature. [taken from Dermatology based on evidence of efficacy, by Luigi Naldi, Alfredo Rebora].
Symptoms
To learn more: Symptoms Erysipelas
The erysipelas tends to spread in some peculiar areas: the face, legs and arms are the most common loci of infection. Some texts define the onset of “dramatic” disease, characterized by alteration of body temperature (low-grade fever or high fever), sensation of cold and chills, headache and perception of local burning, followed by the actual clinical manifestations of the disease.
Patients with erysipelas have shiny red spots (erythematous patches) on the skin, slightly raised, slightly warm to the touch; the affected areas appear swollen, sometimes painful under pressure. Often times, the erysipelas degenerates forming pustules, blisters, blisters and itching. Most responsible are streptococci which, once penetrated through the small wounds of the skin, reach the lymphatic vessels where they cause exudation and inflammation, also affecting the surrounding lymphatic glands (eg the inguinal lymphatic glands are potential targets of erysipelas, especially when the infection affects the lower limbs). Some subjects suffering from erysipelas have skin necrosis of the areas affected by the infection, as well as succulent and itchy blisters.
Generally, at the level of the face, the erysipelas infects the nose, the cheeks and the eyelids, causing palpebral edema, succulent and itchy blisters, and possible conjunctival secretion. [taken from Infectious diseases by Mauro Moroni, Roberto Esposito, Fausto De Lalla].
Risk factors
It is believed that the onset of erysipelas and its subsequent degeneration are favored by some risk factors: obesity, diabetes mellitus, deep venous insufficiency, lymphedema at the level of the legs, tinea pedis, microlesions, wounds, insect bites, responsible - the latter - of the laceration of the skin, a possible access route for bacterial colonization.
Complications of erysipelas
Fortunately, complications are rare, although possible: it is estimated that only in 1% of patients suffering from erysipelas, the disease degenerates into endocarditis at the level of the aortic valve.
In other cases, erysipelas may evolve into abscesses, glomerulo-nephritis (renal phlogosis) or secondary pneumonia (extremely rare event). We have mentioned that the erysipelas could involve the lymphatic vessels, therefore a possible worsening of the disease could cause, in severe patients, elephantiasis.
Furthermore, the umbilical scars of the newborn could act as gateways for the proliferation of staphylococci: consequently, the infected scar could cause a serious infection to the newborn, which appears cyanotic, suffering and jaundiced.
When bacteria enter the bloodstream, they could generate severe sepsis (septicemia), due to streptococcal colonization in the blood and proliferation of toxins.
Certainly, the most serious complication of erysipelas is necrotizing fasciitis (rare bacterial phlogosis of the deep cutaneous and subcutaneous layer).
Other complications of erysipelas include: osteitis, arthritis, tendinitis, thrombosis of the venous sinuses. [taken from Dermatology based on evidence of efficacy of Luigi Naldi, Alfredo Rebora].
Diagnosis
Generally, to diagnose erysipelas, the doctor uses the simple physical examination (clinical diagnosis); for further diagnostic confirmation, some indicators of bacterial inflammation (eg procalcitonin) are useful, although the isolation of the pathogenic bacteria is sometimes not so simple.
In some cases, the diagnosis could be incorrect: in order to overcome this problem, the biopsy could be a valid diagnostic test, useful for distinguishing erysipelas from other non-infectious diseases, but of an inflammatory nature (eg erysipeloid carcinoma). When the diagnosis is incorrect, an inflammatory carcinoma of the breast could be mistaken for a "simple" erysipelas.
The clinical manifestations caused by erysipelas must not be confused with those generated by herpes zoster or contact dermatitis.
Care
To learn more: Drugs for the treatment of Errisipela
The shock therapy useful to fight bacterial infection is based on the administration of antibiotics: when the responsible bacterial strain is isolated, the patient is prescribed specific antibiotics, including benzatin benzyl penicillin (or clindamycin, if the patient is allergic to the penicillin), macrolides (eg erythromycin) and cephalosporins in general.
The use of NSAIDs (Non Steroidal Anti-Inflammatory Drugs) is absolutely prohibited in case of erysipelas, as it could potentially favor the progression of the infection in more complicated forms.
Generally, the improvements are almost immediate: the responsible bacterium is eradicated, so the patient recovers from erysipelas within a few days.
Recurrences of erysipelas are possible: in such situations it is advisable to keep the patient under control, who are generally prescribed specific pharmaceutical specialties for the prophylaxis of recurrences (eg mycotic erysipelas).
Summary
To fix the concepts ...
Disease | Erysipelas |
Description of the disease | Acute cutaneous infection, with evident involvement of the dermis, hypodermis and lymphatic vessels |
Incidence | Disease typical of childhood and senescence Not widespread in Italy Common in France (10-100 cases per 100, 000 healthy subjects) |
Etiological research |
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Most affected anatomical areas |
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Clinical manifestations | Onset: dramatic with fever, cold, chills, local burning Evolution: swollen and erythematous patches on the skin, pustules, blisters, blisters and itching At the level of the lymphatic vessels: exudation and inflammation Degeneration of the disease: cutaneous necrosis of the areas affected by the infection, as well as succulent and itchy blisters, palpebral edema, possible conjunctival secretion |
Risk factors | Obesity, diabetes mellitus, deep venous insufficiency, leg lymphedema, tinea pedis, microlesions, wounds, insect bites |
Complications | Rare but possible: endocarditis at the level of the aortic valve, abscesses, glomerulo-nephritis (renal phlogosis), secondary pneumonia, elephantiasis, severe infection of the newborn, septicemia due to streptococcal colonization in the blood, necrotizing fasciitis, osteitis, arthritis, tendinitis, thrombosis of the venous breasts |
Diagnosis |
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Treatment against erysipelas | Isolated the responsible bacterial strain, specific antibiotics are prescribed to the patient:
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