erysipelas

Erysipelas is a common acute inflammation of the lymphatic vessels of the skin, which is localized. Starting from small skin injuries, it can affect the face, as well as the arms, legs and, more rarely, the navel.

In most cases, erysipelas is triggered by bacteria called streptococci (of group A, rarely also G). Occasionally, other types of bacteria may also cause the disease, such as staphylococci. The development of the disease is favoured by a weakened immune system. This is also the reason why mainly old people are at risk.

As already mentioned above, the trigger of erysipelas is the bacterium Streptococcus pyogenes (in rare cases also Staphylococcus aureus). The bacteria enter the lymphatic vessels of the skin via skin injuries, such as skin cracks in the interdigital spaces, eczema on the ear or in the auditory canal.

Elderly people are particularly susceptible to erysipelas, as are people who suffer from athlete's foot or wounds and ulcers (leg ulcers, for example). If these conditions are present, the skin's defence function is reduced, which favours a erysipelas infection. Risk factors also include circulatory disorders in the legs (PAVK) and alcoholism. Diabetics are also at high risk.

The most frequently affected skin areas are the lower legs, feet, face and arms.

The incubation period can range from a few hours to two days. Initial symptoms may include sudden headache, fever, nausea and chills, usually accompanied by a severe feeling of illness. In addition, a painful burning sensation may be felt in the affected skin area.

After a few hours to a maximum of one day after the appearance of the first symptoms, a bright red erysipelas forms around the entry point of the bacteria. If the infection is superficial, the affected area is sharply defined. If, on the other hand, there is a deeper infection, the boundaries can also become blurred. In most cases, the resulting extensions are tongue- or flame-shaped. The affected skin area shows the following characteristic symptoms of erysipelas:

• Warming of the skin
• Swelling (oedema)
• Redness
• Pressure pain
• Swelling of the lymph nodes

Most often, the diagnosis of erysipelas can be made by the doctor without any problems. The typical appearance is already characteristic, on the basis of which one can recognize the symptoms.

To be sure, a blood sample can be taken and a smear taken from the reddened skin region. If an inflammation is present, the leukocyte values in the blood are increased, as well as the C-reactive protein (CRP). Blood sedimentation is accelerated. If it is erysipelas, there are also antibodies in the blood that go to streptococci or staphylococci. With the help of a smear from the affected skin area, the bacteria can be detected directly. However, this diagnostic method is often not possible.

It is also essential to find and treat the entry sites of the pathogens. In addition, the doctor should clarify diseases that create favorable conditions for erysipelas. These include vascular diseases or diabetes (diabetes). In addition, Lyme disease must be ruled out.

Patients suffering from erysipelas usually undergo inpatient treatment:

• There is bed rest
• The affected body region is elevated and should be immobilized.
• At the same time, a high-dose penicillin therapy is administered. If the patient is allergic to penicillin, a different antibiotic is given.
• This is administered via an infusion into the vein of the affected person.
• If the inflammation subsides, further treatment with compression therapy (e.g. application of a compression bandage) should be given.
• Thrombosis should be counteracted with the aid of appropriate medication.

If erysipelas is treated early, the prognosis is usually positive. However, complications can occur from time to time.

If erysipelas spreads into the deeper layers of the skin, so-called phlegmons can develop, which can be life-threatening. Phlegmons are infections of the deeper skin layers with diffuse (undifferentiated) spread along muscles and tendons.

If the entry site through which the bacteria enter the skin does not heal, or if antibiotic therapy is unsuccessful, erysipelas may recur.

The most common entry site for erysipelas is the athlete's foot infection between the toes (interdigital mycosis). Recurring (recurrent) infections can result in lymphedema.

In order to keep the risk of a recurrent disease as low as possible, it is recommended for high-risk patients, such as diabetics, to make use of regular medical foot care.