What happens during erysipelas and what forms there are
Streptococcus multiplies in the lymphatic capillaries of the skin and releases toxins, which is why inflammation quickly spreads and is accompanied by severe intoxication. Based on the type of lesion, there are erythematous forms with redness and swelling, bullous forms with blisters, hemorrhagic forms with hemorrhages, and necrotic forms with tissue necrosis. According to the course, primary, repeated and recurrent erysipelas are distinguished. Repeated episodes damage the lymphatic vessels, resulting in persistent swelling, increasing the risk of further exacerbations.
- Erythematous form
- Erythematous-bullous - with blisters
- Hemorrhagic - with hemorrhages
- Necrotic form
- Primary, repeated and recurrent erysipelas
Causes and risk factors
Streptococci are common, but erysipelas develops with a combination of the entrance gate and disturbances in local circulation and lymphatic drainage. The most common door to infection on the feet is foot fungus with cracks between the toes. Predisposed by varicose veins, chronic swelling of the legs, obesity, diabetes mellitus, and previous operations involving the removal of lymph nodes. Often the disease occurs after hypothermia, injury, or shortly after streptococcal sore throat.
- Fungal infection of feet and nails
- Cracked heels, abrasions, bites
- Varicose veins and chronic venous insufficiency
- Lymphostasis, including after removal of lymph nodes
- Obesity and diabetes
- Previous episodes of erysipelas
Symptoms
Typically acute onset: chills, temperature up to 39–40 °C, headache, weakness, and sometimes nausea. After a few hours or the next day, burning and pain appear in the skin, followed by redness. The lesion is bright red, hot, swollen, with a clear, uneven border resembling flames, and a ridge along the edge. The nearby lymph nodes become enlarged and painful, and a red stripe may appear along the lymphatic vessels. In the bullous form, blisters form on the reddened skin.
- Chills and high temperature
- Bright red hot spot with sharp edges
- Swelling and pain
- Blisters in the bullous form
- Enlarged and painful lymph nodes
- Weakness and headache
Diagnostics
The diagnosis is made on the basis of an acute onset, a characteristic lesion and the presence of an entrance gate. In a blood test, leukocytes and ESR are usually elevated, and C-reactive protein increases. Everyone's glucose levels are checked, as undiagnosed diabetes makes the course worse. In case of swelling of the leg, ultrasound examination of the veins helps to exclude deep vein thrombosis, and ultrasound of soft tissues helps to exclude abscess and phlegmon. Erysipelas is distinguished from contact dermatitis, thrombophlebitis, gouty arthritis and necrotizing fasciitis.
- Examination by an infectious disease specialist or surgeon
- General blood test
- C-reactive protein
- Blood glucose
- Ultrasound of the veins of the lower extremities
- Ultrasound of soft tissues for suspected suppuration
Treatment and prevention of relapses
The basis of treatment is antibiotics; The drug and course duration are determined by the doctor. Mild forms are treated at home, but with high fever, blisters, erysipelas on the face, concomitant diabetes and in the elderly, hospitalization is required. The limb is kept in an elevated position, while foot fungus and cracks are treated. Warming compresses and ointments under the bandage should not be used independently. In case of suppuration and necrosis, the surgeon opens and cleans the lesion. With frequent relapses, the doctor may prescribe long-term antibiotic prophylaxis.
- Treat foot fungus and cracked heels
- Take care of the skin of your feet, use softening creams
- Treat varicose veins and wear compression stockings as directed
- Control weight and blood sugar
- Treat abrasions and cuts
- Do not interrupt the course of antibiotics, even if you feel better