Erysipelas : Symptoms and Treatment
Erysipelas (Saint Anthony’s fire) is an infection of the superficial layers of the skin and cutaneous lymphatics. The infection is almost always caused by Î²-hemolytic streptococci, with S. pyogenes (group A streptococci) responsible for most infections.
Erysipelas manifests as a bright red, edematous, indurated, and painful lesion sharply circumscribed by an elevated border. Leukocytosis is common. Patients often experience flulike symptoms (fever and malaise) prior to the appearance of the lesions. More severe infections can result in vesicles (pox or insect bite-like marks), bullae (blisters), and petechiae (small purple or red spots), with possible skin necrosis (skin death). Lymph nodes may be swollen, and lymphedema may occur. Occasionally, a red streak extending to the lymph node can be seen.
The lower extremities are the most common sites for erysipelas.
Mild to moderate cases of erysipelas in adults are treated with procaine penicillin G, 600,000 units intramuscularly twice daily, or penicillin VK, 250 to 500 mg orally four times daily, for 7 to 10 days.
Penicillin-allergic patients can be treated with clindamycin, 150 to 300 mg orally every 6 to 8 hours (10 to 30 mg/kg/day in three to four divided doses for children). For more serious infections, aqueous penicillin G, 2 to 8 million units daily, should be administered intravenously.