Erysipelas

The erysipelas is an infection of the top layers of skin, caused by bacteria. It has almost the same symptoms as cellulitis, another type of skin infection. Even if cellulitis infects the deeper skin layers, the two diseases looks very similar and the treatment is almost identical.

The infection causes a very acute rash, which gives the disease the alternative name of St. Anthony's Fire. It is caused by bacteria that enter the skin and usually attack the lymphatic system.

The pathogen that causes strep throat, the Group A Streptococcus bacterium, is the most common cause of erysipelas. The erysipelas usually affects the legs or the face. Large patches of skin turn red, with a raised profile from the healthy areas around them. More serious symptoms can also occur, such as fever, blisters or chills.

Although erysipelas is very similar to another skin disease named cellulitis and usually considered to be a variant of it, there are a number of differences. Erysipelas only emerges in specific locations and is triggered by an infection with the streptococcus bacteria. By contrast, cellulitis can appear anywhere on the skin and can be caused by multiple pathogens.

Before antibiotics were discovered, a strain of the disease affected pigs and was a serious menace for farmers. The swine erysipelas was usually lethal to the animals and spread rapidly, infecting all of the pigs at the farm. The pig variant of the disease started on the skin like the human one but did not stop there. After the whole skin area became infected, it killed the animals by attacking their internal organs. Modern antibiotics are very effective against erysipelas and today pigs are normally given a few doses as a prevention.

Today, erysipelas has become a very rare condition. However, this was not the case in the past, when the lack of antibiotics made it a very dangerous disease. If is not treated immediately, the infections spreads to the joints and eventually the heart. Many famous people and historical figures have been killed by this disease. Without antibiotics, there was no effective way to stop the progress of the infection, which usually reached the joints, causing severe and constant pain. The disease was one of the reasons for opium addiction during the Victorian Age, as a desperate attempt to get rid of the pain in the articulations.

What are the symptoms of erysipelas?

This condition causes areas of the skin to become red and swollen. These patches are clearly delimited and can also cause heat or pain.

In more severe cases, there are a number of other possible problems on the skin, such as rashes on the face, arms or legs, the appearance of blisters full of pus, lesions with red borders and very shiny red rashes. Under the lesions, the skin can be very warm and inflamed, with a violent red color, causing serious pain. The sores known as erysipelas lesions usually develop on the cheeks or the bridge of the nose. Other symptoms can be headache, fever, chills, shaking, vomiting or fatigue. The infection sometimes causes lymph nodes in the area to become inflamed, swollen and painful.

The distinctive pattern of erysipelas usually makes the disease easy to recognize. It begins with a rash with raised edges, which expands very quickly on the face. It ends up looking like a butterfly, covering the nose and both cheeks. Damage to the tiny blood vessels in the skin leads to bleeding, which gives the rash a purple or orange color. It is hard to confuse it with cellulitis because of this particular color combined with swelling.

Usually, the rash hurts and other signs of severe infections develop, such as chills or fever. It is a dangerous disease that should not be ignored, contact your doctor in order to start the treatment immediately.

What causes erysipelas?

When the bacteria Group A Streptococcus manages to breach the skin and enters the first layers, the infection begins. These bacteria live on the skin surface and are normally harmless but cause problems as soon as they manages to enter through a cut or a crack. As a result, the disease is sometimes causes by eczema, athlete's foot and other conditions that damage the skin. Infections of the nose or throat can also allow the bacteria to infiltrate nasal channels and cause erysipelas.

There are other situations when the skin is breached, allowing the infection to start. These include surgical procedures, insect stings, skin ulcers, skin diseases like psoriasis. Diabetes or some heart issues can cause the legs to become swollen, which triggers erysipelas. The skin can also be breached by drug addicts, while injecting heroin and other illegal substances.

Any minor skin injury, like a cut or bruise, can in theory trigger the erysipelas by allowing the bacteria to penetrate the deeper layers. In many cases however, the condition begins on healthy skin due to local immunity problems, such as obstructions of the lymphatic system.

Treatment options

The normal treatment at the onset of the erysipelas is based on the classic antibiotic penicillin. An oral cure of penicillin or a related antibiotic lasts two weeks. More modern antibiotics are used if a person is allergic to penicillin. Very serious infections need intravenous antibiotics, usually penicillin delivered through an intravenous line.

The rash expands fast and the pathogen has a tendency to become established in the joints. Once it is settled there, it can no longer be removed. People who don't treat in time an eruption on the legs or face will need to take antibiotics for life, just to keep the pain in the joints at a manageable level. This rarely happens however, since erysipelas is very painful from the start and is very hard to ignore.

If the bacteria reache the blood stream, it produces a complication named bacteremia. Through the blood, the infections can extend to the entire body, usually attacking the joints, bones and heart valves.

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