What is Erysipelas (St. Anthony’s Fire)?
Erysipelas is a type of skin infection that usually affects the dermis, which is a layer of your skin, and can sometimes reach the shallow parts of your skin’s lymphatic system. This infection causes a distinctive red rash that is well-marked, raised, and usually appears on the lower part of the body or the face.
Interestingly, erysipelas is sometimes called “St. Anthony’s Fire” because of the intense, fiery nature of the rash it causes. It can be hard to distinguish this infection from another called cellulitis, as both diseases present similar symptoms. However, erysipelas usually develops faster and with clearer boundaries than cellulitis, which develops slower and with fuzzier boundaries.
Erysipelas can be quite severe, but it’s rarely life-threatening. The good news is that it typically responds well to antibiotic treatments. Local complications, or problems at the site of the infection, are more common than systemic complications, problems that affect the entire body.
The primary culprit behind this infection is a bacterium known as group A streptococci.
What Causes Erysipelas (St. Anthony’s Fire)?
Most facial skin infections are caused by a specific type of bacteria called Group A streptococcus, whereas non-Group A streptococcus more often affects the lower body. A study in Norway found that beta-hemolytic streptococci, a type of bacteria, was the main cause of a face condition called cellulitis. For newborns, Group B streptococcus is the main cause of a skin infection that occurs after childbirth known as erysipelas.
Erysipelas begins with breaks in the skin, enabling the responsible bacteria to enter the body. There are many ways the bacteria can enter, such as from surgical cuts, insect bites, ulcerations (open sores) from poor blood flow, and venous stasis (a condition where blood flow slows down in veins).
Facial erysipelas can also be a result of a recent infection in the nasopharynx passage, which is the space above the soft part of the roof of your mouth and behind your nose.
Contrarily, there is little evidence to suggest that another bacteria, staphylococcus, plays a role in erysipelas.
Some things can make you more likely to develop erysipelas. These include having a vein (the saphenous vein) removed for bypass surgery, having swelling in your lymphatic system (a major risk factor), having blockage in your lymphatic system, having a condition where arteries and veins are connected (arteriovenous fistula), having had surgery (like a mastectomy), suffering from a condition called nephrotic syndrome which causes your body to excrete too much protein in your urine, or having a weakened immune system.
Risk Factors and Frequency for Erysipelas (St. Anthony’s Fire)
Erysipelas is a condition that has been studied in various hospitals across different countries. It can impact anyone, regardless of their age, race, or gender. However, some studies suggest that it might be more common in females. Thanks to the advent of antibiotics and better cleanliness, the incidence of erysipelas has gone down. Nevertheless, it can still affect people at any stage of life, particularly those at the very young or old end of the age spectrum.
- Erysipelas is a condition that can affect people of all age groups, races, and gender.
- Some studies indicate that it might be more common in females.
- The incidence of erysipelas has decreased thanks to antibiotics and improved sanitation.
- While erysipelas can impact anyone, it’s most frequently seen in the very young or old.
Signs and Symptoms of Erysipelas (St. Anthony’s Fire)
Erysipelas is a skin condition that doctors identify based on a patient’s symptoms and medical history, such as recent skin damage or a sore throat. The disease generally comes with full-body symptoms like fatigue, fever, and chills, which begin up to 48 hours before the skin symptoms show up. The main symptom of erysipelas is a specific type of skin redness that is clearly defined and raised. Patients then typically feel a burning sensation, pain, and itchiness at the affected site. In more severe cases, there might be blisters, large fluid-filled sacs, and even tissue death.
It’s also crucial to note the area where the inflammation occurs. If erysipelas affects the lower leg, doctors will check the spaces between the toes for any cracks, flaky skin, or softening because this can indicate the source of the infection. If redness and swelling occur around a joint, it could signify other, more severe diseases like septic arthritis – a severe and urgent condition where a joint fast becomes painful and swollen due to bacterial infection.
Testing for Erysipelas (St. Anthony’s Fire)
No lab tests are usually needed to diagnose a skin infection called erysipelas. Sometimes, doctors may perform tests which may show a high white blood cell count, or high levels of certain proteins in the blood, but these tests generally do not change the treatment approach for otherwise healthy individuals. Blood tests are not usually done for this condition due to their low success rate in providing helpful information.
However, in certain situations, such as in patients with weakened immune systems, patients who seem very ill, or patients suspected of abusing intravenous drugs, more extensive testing may be necessary. Those with artificial heart valves or other medical devices inserted in their blood vessels may also require more tests. Additionally, patients who show signs of being severely ill may need a complete set of tests and medical treatment to stabilize their condition.
Treatment Options for Erysipelas (St. Anthony’s Fire)
If you suspect you have erysipelas, a type of skin infection, your doctor will likely prescribe antibiotics to help fight off the bacteria causing it, typically bacteria called streptococci. Penicillin is often the first choice of treatment. However, there’s debate about whether or not to include extra coverage for a type of bacteria called MRSA (Methicillin-Resistant Staphylococcus aureus), which is resistant to many antibiotics. Some guidelines recommend additional coverage for MRSA in patients with certain risk factors, such as a history of MRSA infections or drug use.
Your doctor might allow you to take oral antibiotics at home. Generally, you would take these for about 5 days, but this could be extended to 10 days if your skin condition doesn’t start to improve. Sometimes, people who have difficulty taking their medications regularly, have other serious health conditions, or are not getting better with outpatient treatment may need to be hospitalized for erysipelas treatment.
Researchers reviewed studies on preventing repeat episodes of skin infections like erysipelas. Their analysis showed a 69% decrease in future episodes for patients who took preventive antibiotics. One study suggested that an antibiotic called Benzathine penicillin G taken every 3 weeks was effective in preventing erysipelas recurrence. However, they couldn’t conclude how long this preventive treatment should last. Some treatment guidelines suggest taking oral penicillin or erythromycin twice a day for several weeks to a year, or getting intramuscular benzathine penicillin shots every 2 to 4 weeks, especially for patients who have repeated skin infections despite other preventive measures.
Alongside antibiotics, you might also be recommended supportive treatments to alleviate symptoms. These could include staying hydrated, using cold compresses, taking acetaminophen to reduce fever, and keeping the infected area elevated.
If there is an abscess (a pocket of pus) or gangrene (dead tissue due to infection), a surgical treatment to clean out the infected area might be needed. Hospitalization is often recommended for infants, elderly, and people with weaker immune systems to ensure they receive proper care and monitoring.
What else can Erysipelas (St. Anthony’s Fire) be?
There are several diseases that can resemble erysipelas, all presenting with symptoms such as redness, warmth, swelling, and pain. These include both more serious conditions and less severe ones.
More serious conditions to consider include:
- Septic bursitis
- Septic arthritis
- Necrotizing fasciitis
- Orbital cellulitis
- Deep vein thrombosis
- Phlegmasia cerulea dolens
- Flexor tenosynovitis
- Toxic shock syndrome
Less serious conditions to consider include:
- Cellulitis
- Abscess
- Felon
- Gout
- Paronychia
What to expect with Erysipelas (St. Anthony’s Fire)
Erysipelas, a type of skin infection, generally has a good prognosis and can usually be managed outside of a hospital setting. It typically responds well to treatment with oral antibiotics. However, we should be extra careful with patients who have weak immune systems and those who may not strictly follow their medication regimen.
If the condition is severe, hospitalization and treatment with intravenous antibiotics are recommended, especially for patients with compromised immunity, infants, and elderly people. It’s also important to closely monitor and assist those who, due to psychological or social reasons, are likely to have difficulty following the treatment instructions or completing their course of antibiotics.
Possible Complications When Diagnosed with Erysipelas (St. Anthony’s Fire)
Erysipelas complications can be severe but are seldom life-threatening. These complications may include the formation of abscesses, scarlet fever, pneumonia, meningitis, skin decay, hemorrhagic purpura (a condition where small blood vessels leak blood into the skin), inflammation of a vein associated with a blood clot (thrombophlebitis), and the formation of fluid-filled blisters (bullous formation). In one recorded instance, erysipelas led to a condition called elephantiasis (swelling in certain body parts) in both legs and the stomach because of erysipelas.
A study that surveyed 152 cases of erysipelas found that the risk of developing these complications increases if the patient had taken empirical (experience-based) antibiotics and had high ESR (Erythrocyte Sedimentation Rate, a blood test that can reveal inflammatory activity in your body) at the time of admission to the hospital.
Moreover, the affliction can recur within 5-20% of patients, which can ultimately lead to scarring.
Common Complications:
- Abscess formation
- Scarlet fever
- Pneumonia
- Meningitis
- Skin necrosis
- Hemorrhagic purpura
- Thrombophlebitis
- Bullous formation
- Local recurrence leading to scarring
Preventing Erysipelas (St. Anthony’s Fire)
If the patient’s arm or leg is affected, they should wear tight-fitting socks, known as compression stockings. This can help manage swelling and discomfort. Furthermore, some patients may need to take antibiotics for a longer period of time to completely get rid of the infection.
