Erysipelas

Erysipelas is an acute infectious disease of the skin and subcutaneous tissue caused by group A beta‑hemolytic streptococcus. It is characterized by a sharply demarcated, bright‑red focus of inflammation accompanied by pronounced systemic toxicity.

Unlike phlegmon or cellulitis, erysipelas is a superficial process that spreads primarily along the lymphatic vessels of the dermis. This explains the characteristic appearance of the lesion, with its distinct, “geographic” borders.

Aetiology and Pathophysiology

In the majority of cases, the causative agent is Streptococcus pyogenes. The infection enters the skin through microtraumas such as abrasions, cracks, sores, or fungal lesions of the feet. Multiplying within the lymphatic capillaries of the dermis, the streptococcus provokes a vigorous inflammatory reaction, edema, and marked hyperemia.

Clinical significance

The onset of the disease is abrupt, with a sudden fever, chills, and symptoms of systemic toxicity. Soon, a painful, warm, red patch appears on the skin, which rapidly enlarges. Its edges are sharply demarcated from the surrounding healthy skin and form a raised border, sometimes with tongue‑like projections (“flames”).

Diagnosis is established based on the typical clinical presentation. The cornerstone of treatment is systemic antibiotic therapy, with penicillin remaining the drug of choice. Timely treatment leads to complete recovery; however, the disease may evolve into a recurrent condition, which may result in elephantiasis (lymphedema) of the affected limb.

Differential Diagnosis

Erysipelas must be differentiated from cellulitis. Cellulitis is characterized by a deeper, diffuse inflammatory process without clear borders or raised edges, and its causative agents may include not only streptococci but also staphylococci.