What are the other Names for this Condition? (Also known as/Synonyms)

• Holy Fire
• Ignis Sacer
• St. Anthony's Fire

What is Erysipelas? (Definition/Background Information)

• Erysipelas is a common but potentially serious skin condition caused by a bacterial infection. It affects the superficial skin layers (epidermis) resulting in the formation of large red patches, commonly in the face and lower limbs
• Without adequate treatment, Erysipelas may lead to severe complications including widespread systemic infections. The condition is mostly observed in young children, older adults, and immunocompromised individuals
• A diagnosis of Erysipelas requires a physical exam, blood tests, and skin swab culture to detect the causative bacteria. Antibiotics are the mainstay of treatment for Erysipelas. Also, maintaining personal hygiene and cleanliness is important in early resolution of the condition

Who gets Erysipelas? (Age and Sex Distribution)

• Erysipelas may affect individuals of any age; although, young children (usually 2-6 years old) and elderly adults (over 60 years old) are more prone to the condition
• It affects both males and females without any predilection
• There is no preference for any racial or ethnic group, and the condition is seen worldwide

What are the Risk Factors for Erysipelas? (Predisposing Factors)

The risk factors associated with Erysipelas may include:

• Older adults and individuals with weak immune systems are more susceptible
• Children less than 6 years of age (because their immune system is in the developing stage)
• Vaccination sites in children
• Infection may occur through the umbilical cord in infants
• Scabies: A skin condition caused by parasitic mites
• Pre-existing wounds, skin ulcers, or surgical wounds
• Insect bites
• Poorly-controlled diabetes
• Individuals who are overweight or obese have a higher risk
• HIV infection
• Use of medication that can suppress the immune system
• Any other condition that causes a weak or poor immunity (such as organ transplant or chronic illness)
• Skin disorders such as psoriasis and eczema
• Fungal infections such as athlete’s foot
• Chronic alcoholism
• Cancer treatment such as radiotherapy
• Throat or sinus infection
• Pedal edema (swollen feet) from kidney disease, heart failure, etc.
• Use of recreational drugs via injections
• Individuals, who had Erysipelas earlier, have an increased risk for recurrence of the condition
• Pregnancy

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Erysipelas? (Etiology)

Infection by the following bacterium can cause Erysipelas:

• Commonly, it is caused by Streptococcus pyogenes (Group A Streptococcus)
• Occasionally, Haemophilus influenzae, Klebsiella pneumoniae, Staphylococcus aureus (including MRSA), Streptococcus pneumoniae, and Yersinia enterocolitica are known to be causative

Typically, these bacteria enter human skin through open cuts and wounds, or weaknesses in the skin. Erysipelas resembles another skin infection, termed cellulitis, which involves the deeper layers of skin. 

What are the Signs and Symptoms of Erysipelas?

The signs and symptoms of Erysipelas may vary from one individual to another and may be mild or severe. The infection has a sudden onset, affecting the lower legs or the face (cheeks, ears, around eyes); large areas of the skin surface may be affected. In infants, the region around the umbilical cord (navel) or diapers may show skin discoloration.

The signs and symptoms of Erysipelas may include:

• Presence of well-demarcated bright red skin that is inflamed/swollen
• The affected skin may present “fine dimples”, or an orange peel appearance from accentuation of the follicle openings
• The outer layer of skin (or epidermis) and upper dermis is typically affected. It may be warm to touch
• Erysipelas may penetrate deeper into other skin layers in severe cases, and present bleeding (purpura)
• The skin may blister and present necrosis (tissue death)
• Pain and discomfort may be noted
• Following ulceration, the skin lesion develops an overlying yellow crust
• Fever and chills may be noted
• Swollen legs (pedal edema), which may be chronic
• Abscess formation
• In some cases, vesicles (small fluid-filled lesions) and bulla (large blisters filled with fluid) may be observed

Additional signs and symptoms of the underlying condition, if any present, may be noted.

How is Erysipelas Diagnosed?

The diagnosis of Erysipelas may involve the following tests and procedures:

• Complete evaluation of medical history along with a thorough physical exam, including examination of the skin sores and blisters
• Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Complete blood count (CBC), C-reactive protein test, and antibody tests
• Blood or wound culture: A culture may be performed to confirm the presence of bacteria and to rule-out other causes of infection. In this culture, a small amount of pus or fluid from one of the sores is collected and sent to the lab for testing. The test results can help confirm the presence and type of bacteria (if any)
• Imaging studies, such as CT or MRI scans, may be necessary in some cases
• Skin biopsy: A skin biopsy is performed and sent to a laboratory for a pathological examination. Rarely in Erysipelas, a small tissue sample will be sent to the lab on sterile saline or tissue medium to grow the causative bacteria. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed), and with microscope findings, the pathologist arrives at a definitive diagnosis

Tests and procedures to diagnose the associated condition, if any present, is important.

A differential diagnosis to eliminate other conditions may be considered, before arriving at a definitive diagnosis. These may include:

• Acute drug reaction
• Angioedema
• Contact dermatitis
• Deep venous thrombosis
• Diffuse inflammatory carcinoma of the breast
• Erythema chronicum migrans (early Lyme disease)
• Gout
• Herpes zoster also known as shingles
• Insect bite allergic reaction
• Septic arthritis
• Septic bursitis
• Vasculitis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Erysipelas?

The complications of Erysipelas are uncommon, but may include:

• Emotional stress due to cosmetic concerns
• Formation of scars upon healing
• Lightening (hypopigmentation) or darkening (hyperpigmentation) of the skin following resolution of the condition
• Gangrene formation in the lesions if severe skin ulcers are left untreated. This can be an emergency medical situation
• Enlarged regional lymph nodes (lymphadenopathy) that may be painful
• Formation of blood clots (in the leg) resulting in thrombophlebitis
• Systemic infection when the whole body is involved/affected 
  • Infection of the bone and joints causing bursitis, septic arthritis, or tendonitis
  • Involvement of the heart valves due to infective endocarditis
  • Involvement of the kidneys causing glomerulonephritis in children
  • Involvement of the brain leading to cavernous sinus thrombosis
  • Sepsis
• Recurrence of the condition due to lymphatic drainage and/or presence of predisposing factors

Complications of the underlying condition, if any present, may be noted.

How is Erysipelas Treated?

The treatment measures for Erysipelas may include:

• Employing hygienic measures, such as keeping the skin region clean
• Symptomatic treatment may involve the administration of painkillers, use of ice packs for local discomfort, and use of compression stockings
• If the legs are involved, keeping it elevated, such as by propping it up on a pillow, to decrease swelling
• The areas around the blisters should be gently washed with soap and running water
• The affected area should be covered lightly with gauze to prevent the spread of infection
• Oral antibiotics, such as penicillin, may be prescribed for mild infections and intravenous antibiotics for severe infections
• Rarely, dead tissue may be cleaned through minor surgical procedures, if necessary

Undertaking treatment of the underlying/associated condition may be necessary.

How can Erysipelas be Prevented?

Following are some of the precautionary measures for preventing Erysipelas:

• Always keep the skin clean and healthy; in case of dry skin, the use of suitable moisturizers is recommended
• Cuts, scrapes, insect and animal bites, and wounds must be washed immediately, and antibiotic ointment applied, to prevent spread of the infection
• Wearing gloves while applying ointment on the blisters is advised. Washing the hands after applying ointment on the blisters is recommended
• Items used by the infected individual, such as towels, clothing, bed, etc., should be washed or cleaned everyday
• Avoid sharing clothes, towels, bed, and any other item of the infected individuals
• The nails of infected children should be cut short so that further infection from scratching the blisters can be avoided
• Application of soothing solutions (calamine or oatmeal-based) on the lesions may reduce itchiness
• Frequent washing of hands
• The infected child or adult is best advised to stay indoors, until he/she recovers fully
• In case of a higher risk for recurrence of Erysipelas, the healthcare provider may recommend the use of prophylactic antibiotics
• Getting treatment for any underlying medical condition(s) that may decrease immunity in the individual

The entire course of medication prescribed by the healthcare provider should be completed for effective cure and prevention of recurrence.

What is the Prognosis of Erysipelas? (Outcomes/Resolutions)

The prognosis of Erysipelas is good with appropriate and prompt treatment. However, the prognosis also depends upon the severity of the infection, development of complications, overall health status of the individual, promptness of treatment, and the individual’s response to treatment.

• With appropriate treatment, the skin condition may subside within about 7 days; although for the skin to return to normalcy, it may take some additional time
• Individuals with an underlying immune deficiency disorder, the elderly, and very young children may be affected more than the others
• Recurrent episodes of Erysipelas are noted in over 30% of the cases, if the causative factors are not addressed

Additional and Relevant Useful Information for Erysipelas:

Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition. Care must be taken avoid strong soaps and chemicals that could potentially worsen the condition.