Etiology and Pathology
Erysipelas is an acute, non-purulent inflammatory condition of the skin and lymphatic network caused by Streptococcus pyogenes (Group B hemolytic streptococci). It commonly affects the lower limbs and face and is often associated with pre-existing lesions on the distant skin or mucous membranes, such as skin injuries on the toes, tinea pedis (athlete’s foot), oral ulcers, or sinusitis. Following infection, the impacted skin area within the lymphatic network exhibits a rapid inflammatory response. The condition typically involves the regional lymph nodes of the affected drainage area, though tissue necrosis or suppuration is rare. Despite the prominent systemic inflammatory reactions, erysipelas is generally curable but tends to recur.
Clinical Presentation
The onset is acute, often accompanied by chills, fever, headache, and general malaise. Lesions predominantly occur on the lower limbs and present as slightly raised reddish plaques on the skin. The lesions are bright red in color, with slightly paler central areas, well-defined borders, and, in some cases, vesicles. Affected areas are typically associated with a burning pain. As the inflammation extends peripherally, the red, swollen central area gradually fades into a brownish-yellow hue. Enlarged and tender regional lymph nodes are frequently observed, though suppuration and rupture are uncommon. Severe cases may result in systemic sepsis.
Recurrent erysipelas may cause lymphatic vessel obstruction and lymphedema, resulting in swelling of the extremities, localized thickened skin, and, in severe cases, "elephantiasis" characterized by chronic lymphedema.
Prevention and Treatment
Maintaining proper skin hygiene and promptly addressing minor wounds are essential measures. Handwashing and disinfection are important for preventing cross-infection when in contact with erysipelas patients or during dressing changes. Associated conditions such as tinea pedis, ulcers, or sinusitis should be actively treated and managed to prevent recurrence.
Rest is recommended, with elevation of the affected limb. Wet compresses with 50% magnesium sulfate solution can be applied locally. Antibacterial therapy, such as intravenous infusion of penicillin or cephalosporin antibiotics, is administered systemically.