Last updated:
May 11, 2009
Years published: 1990, 1995, 1996, 2004, 2009
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.
The typical erysipelas lesion is so characteristic that its presence is diagnostic.
Treatment
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
Email: [email protected]
For information about clinical trials sponsored by private sources, contact:
www.centerwatch.com
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.
TEXTBOOKS
Beers MH, Berkow R, eds. The Merck Manual, 17th ed. Whitehouse Station, NJ: Merck Research Laboratories; 1999:796.
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.
REVIEW ARTICLES
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.
JOURNAL ARTICLES
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.
www.nlm.nih.gov/medlineplus/ency/article/000618.htm
Stanway A. Erysipelas. New Zealand Dermatological Society. Last Updated: 24 April 2002. 2pp.
www.dermnetnz.org/dna.strpt/erys.html
Davis l, Benbenisty K. Erysipelas. emedicine. Last Updated: February 25, 2003. 9pp.
www.emedicine.com/derm/topic129.htm
Morgan JA. Erysipelas. Emergency Medicine Bulletin Board System (EMBBS). nd. 3pp.
www.embbs.com/aem/face-d.html
Moses S. Family Practice Notebook. Last revised 9/6/2003. 4pp.
www.fpnotebook.com/DER24.htm
NIAID. Health Matters. Group A Streptococcal Infections. August 2002. 6pp.
www.niaid.nih.gov/factheets/strep.htm
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