Erysipelas
Definition
Erysipelas is an acute, superficial bacterial skin infection with prominent lymphatic involvement. Lesions are classically well demarcated, bright red, raised above the surrounding skin and warm; a peau d’orange (dimpling) may be seen. It is most commonly caused by streptococci, especially Streptococcus pyogenes. In the UK it is managed alongside cellulitis in NICE guidance (NG141).
Aetiology and risk factors
Erysipelas results from bacterial invasion of the superficial dermis and lymphatics. Predisposing factors include:
- Breaks in the skin (ulcers, fissures, interdigital tinea pedis).
- Lymphoedema.
- Venous insufficiency.
- Obesity.
- Immunosuppression.
- Recent surgery.
- Extremes of age (infants and older adults).
Clinical features
- Sudden onset of a painful, hot, sharply demarcated, raised erythematous plaque.
- Common systemic features include fever, rigors, malaise and regional lymphadenopathy.
- Typical sites are the face (classical facial plaques) and lower legs; periorbital or nasal involvement requires a lower threshold for admission.
- May show lymphangitic streaking, bullae or vesicles.
- Recurrent episodes are common in patients with lymphoedema.