Overview

Erysipelas is a bacterial infection that affects the upper layers of your skin, often appearing as a shiny, raised, and very red rash with clear borders. It's caused by bacteria, most commonly Streptococcus pyogenes (Group A Streptococcus), entering the skin through a cut, scrape, insect bite, or areas with existing skin conditions like eczema or athlete's foot. While anyone can get erysipelas, it's more common in young children, older adults, and individuals with weakened immune systems, lymphedema (swelling due to lymph fluid buildup), or poor circulation.

Erysipelas itself isn't typically contagious from person to person through casual contact, but the bacteria causing it can be spread. Living with erysipelas can be uncomfortable and concerning due to the sudden onset of symptoms and the appearance of the rash, sometimes impacting daily activities due to pain and feeling unwell.

Symptoms

You might experience a range of symptoms with erysipelas, often starting quite suddenly:

A fiery red, swollen, warm, and tender rash - with a sharply defined, raised border. It often looks like an orange peel (peau d'orange).

The rash - commonly appears on the legs or face but can occur anywhere on the body.

Blisters (bullae) - may form on the affected skin in more severe cases.

Fever and chills - often starting before the rash appears.

A general feeling - of being unwell (malaise), headache, or fatigue.

Swollen and tender lymph nodes - near the affected area.

The rash - can spread quite rapidly.

Pain - in the affected area, which can range from mild to severe.

Diagnosis

A doctor can usually diagnose erysipelas based on the distinctive appearance of the rash - and your symptoms. They will look for the characteristic redness, warmth, swelling, and sharply defined edges.

In some cases, especially if the diagnosis isn't clear or if you're not responding to initial treatment, your doctor might:

Take a swab - from the affected skin or any blisters to try and identify the bacteria, though this isn't always necessary or helpful.

Order blood tests - to check for signs of infection, like an elevated white blood cell count.

Management & Treatment

Finding out you have erysipelas can be a bit of a shock, but the good news is that it's very treatable. Our main goal is to get rid of the infection and make you as comfortable as possible while your skin heals. With the right care, you should start to feel better within a couple of days.

Most of the time, erysipelas can be treated at home with a course of oral antibiotics. However, in more serious cases, you might need to be treated in the hospital with intravenous (IV) antibiotics.

Antibiotic Treatment

Since erysipelas is a bacterial infection, antibiotics are the cornerstone of treatment.

• Oral Antibiotics: For most cases, your doctor will prescribe an antibiotic pill that you can take at home. Penicillin is the most common choice, but if you have a penicillin allergy, there are other effective options like clindamycin, erythromycin, or cephalexin. It's so important to take the full course of antibiotics, even if you start to feel better, to make sure the infection is completely gone.
• Intravenous (IV) Antibiotics: If the infection is more severe, covers a large area of your body, or if you have a high fever and feel very unwell, your doctor might recommend treatment in the hospital with IV antibiotics. This allows the medicine to get into your system more quickly and is the safest approach for more serious infections.

Supportive Care at Home

While the antibiotics are fighting the infection, there are several things you can do at home to help with the discomfort and speed up your recovery:

• Rest and Elevate: If the erysipelas is on your arm or leg, keeping it elevated above the level of your heart can help reduce swelling and pain.
• Cool Compresses: Applying cool, damp cloths to the affected area for 15-20 minutes a few times a day can be very soothing.
• Pain Relievers: Over-the-counter pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) can help with pain and fever.
• Keep the Skin Clean and Moisturized: Gently clean the affected area with mild soap and water. Once it's dry, applying a gentle, fragrance-free moisturizer can help with any dryness or peeling as it heals.

Managing Recurrent Erysipelas

Unfortunately, some people are prone to getting erysipelas again. If this happens to you, please don't be discouraged. We have ways to manage this. The most important step is to address any underlying issues that might be allowing the bacteria to get in, such as:

• Treating any skin conditions: Conditions like athlete's foot, eczema, or stasis dermatitis can create breaks in the skin. Keeping these conditions well-managed is key.
• Managing Swelling: If you have lymphedema (chronic swelling), your doctor may recommend compression stockings or other therapies to help control it.
• Preventative Antibiotics: For people who have had multiple episodes of erysipelas, a low-dose, long-term antibiotic may be prescribed to prevent future infections.

Important Warning

While most cases of erysipelas are straightforward to treat, it's important to watch for any signs that the infection is getting worse. Please seek medical care right away if you notice:

• The redness and swelling are spreading rapidly
• You develop a high fever with chills
• The pain becomes severe
• The skin turns a dusky or purple color
• You feel dizzy, confused, or have a rapid heart rate

These could be signs of a more serious infection that needs immediate medical attention. We're here to help you through this, so never hesitate to reach out to a healthcare professional if you're concerned.

Duration & Outlook

Erysipelas is an acute condition, meaning it comes on suddenly. With prompt and appropriate treatment, the infection usually starts to improve within 24 to 48 hours, and the rash typically resolves within one to two weeks. However, some skin discoloration or mild swelling might persist for a bit longer.

It's important to complete the full course of treatment prescribed by your doctor to ensure the infection is fully cleared. Unfortunately, erysipelas can sometimes recur, especially in individuals with ongoing risk factors like lymphedema or breaks in the skin.

Warning signs for complications

include the rash spreading very rapidly, high fever that doesn't improve, signs of severe illness (like confusion, rapid heartbeat, or difficulty breathing), or the development of purple or black areas within the rash. If you notice any of these, seek medical attention immediately.

Prevention

While not all cases of erysipelas can be prevented, you can take steps to reduce your risk:

Practice good skin hygiene: - Keep your skin clean and moisturized to prevent dryness and cracking.

Promptly clean and cover any cuts, scrapes, or insect bites - with an antiseptic and a bandage.

Treat underlying skin conditions - like athlete's foot, eczema, or psoriasis effectively to prevent breaks in the skin.

If you have lymphedema, follow your doctor's advice - for managing the swelling, which may include compression garments or specific exercises.

Maintain good foot care - especially if you have diabetes or circulation problems.

Causes & Triggers

Erysipelas is caused by bacteria entering the outermost layers of your skin. The most common culprit is Streptococcus pyogenes (Group A Streptococcus), the same bacteria that can cause strep throat. Other bacteria, like Staphylococcus aureus, can also sometimes be involved.

These bacteria typically get in through:

Breaks in the skin: - Cuts, surgical wounds, insect bites, scratches, or even tiny, unnoticed cracks.

Skin conditions: - E eczema, athlete's foot, psoriasis, or impetigo can create entry points for bacteria.

Ulcers or sores - on the skin.

Who is most likely to develop it?

• Young children - (especially infants) and older adults (over 60).
• People with lymphedema - (swelling caused by lymphatic system blockage).
• Individuals with venous insufficiency - (poor blood flow in the veins).
• Those with breaks in the skin - due to injury, surgery, or skin conditions.
• People with a weakened immune system - (e.g., due to diabetes, HIV/AIDS, or certain medications).
• Individuals who have had erysipelas before - are at higher risk of recurrence.
• Obesity - can also be a risk factor.

When to see a doctor

It's important to see a doctor as soon as possible if you suspect you or your child might have erysipelas. Early treatment is key to preventing the infection from spreading or causing complications.

Look for these signs:

A red, swollen, warm, and tender rash - that is spreading.

The rash - has sharply defined, raised edges.

You or your child develop a fever and chills - especially if they occur before or alongside the rash.

You feel generally unwell - with headache or fatigue accompanying the skin changes.

Seek immediate medical attention if:

• The rash - is spreading very rapidly.
• **You develop a high fever.
• The person with the rash - seems very ill, confused, or lethargic.
• There are signs - of a more severe infection, such as blisters forming, or the skin turning purple or black.

Frequently Asked Questions (FAQs):

• Is erysipelas the same as cellulitis? Erysipelas and cellulitis are both bacterial skin infections, but erysipelas affects the upper layers of the skin (dermis) and has very distinct, raised borders, while cellulitis affects deeper layers and has less defined edges. Your doctor can tell the difference.
• Can erysipelas leave scars? In most cases, erysipelas does not leave scars if treated promptly. However, there might be some temporary skin discoloration or peeling as it heals. Severe cases or those with complications like blisters might have a higher chance of minor skin changes.
• If I've had erysipelas once, will I get it again? Unfortunately, having erysipelas once does increase your risk of getting it again, especially if you have underlying risk factors like lymphedema or recurrent skin breaks. Taking preventative measures is important.
• Why does erysipelas often occur on the legs or face? The legs are common sites due to increased risk of skin breaks, swelling (lymphedema or venous insufficiency), and conditions like athlete's foot providing entry points for bacteria. The face can be affected due to nasal passages harboring bacteria or minor skin injuries.
• Is it safe to be around someone with erysipelas? Erysipelas itself isn't directly contagious through casual contact like a cold. However, the bacteria causing it (Streptococcus) can be spread through direct contact with an open wound or nasal discharge from an infected person. Good hand hygiene is always recommended.

We understand that dealing with a skin condition like erysipelas can be worrying. Please remember, this information is for educational purposes, and it's always best to consult with a healthcare professional for diagnosis and guidance. They are there to help you understand your specific situation and get the care you need.

References

• Dalal A, Eskin-Schwartz M, Mimouni D, et al. (2017). Interventions for the prevention of recurrent erysipelas and cellulitis. Retrieved from https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009758.pub2/full
• Cleveland Clinic. (2022). Erysipelas. Retrieved from https://my.clevelandclinic.org/health/diseases/23221-erysipelas
• Merck Manuals. (2023). Erysipelas. Retrieved from https://www.merckmanuals.com/professional/dermatologic-disorders/bacterial-skin-infections/erysipelas
• Raff, A. B., & Kroshinsky, D. (2016). Cellulitis: A Review. JAMA, 316(3), 325–337. Retrieved from https://jamanetwork.com/journals/jama/fullarticle/2533318