Erysipelas, a bacterial skin infection

How does erysipelas develop?

Erysipelas (orbánc) is usually caused by bacteria called Streptococcus pyogenes.

These bacteria enter your body through injuries, cracks or wounds in your skin. Minor cuts, abrasions, burns, wounds or even insect bites can serve as "entry points."

Healthy skin has a protective layer that prevents bacteria from entering. However, if the skin is damaged or the immune defense is weakened, this protective layer is compromised and bacteria can more easily invade.

How does erysipelas spread?

Patients often worry that family members might catch the infection.

This fear is only partly justified. Erysipelas is not considered highly contagious. Direct contact with the bacterium is required, and infection generally occurs only if the skin's protective barrier is broken.

In simple terms, a relative could catch erysipelas if they thoroughly touch your inflamed skin, stroke it, and then transfer the bacteria with their hand into a wound, eye or mouth on their own body.

If, after touching your leg, they wash their hands well and disinfect them (e.g. with a household bleach solution), the chance of them catching the disease is minimal.

The pathogen is not spread through the air, so merely being in the same room with you does not transmit it.

Direct contact with infected skin is necessary. If you care for erysipelas-affected skin, pay extra attention to hygiene. Use rubber gloves and ensure proper hand disinfection.

Symptoms of erysipelas

It most often appears on the lower limb, but can also occur on other areas of the skin such as the arms, buttocks, abdomen, and even the face. Based on its symptoms, it is usually easy to recognize.

• Redness: The affected area becomes markedly red. Erysipelas does not remain at the point of entry but begins to spread.
  The skin has a rich network of lymphatic vessels, and once bacteria enter the lymphatics they start to spread there.
  One characteristic sign of erysipelas is that the redness spreads upward along the lymphatic vessels from the point of entry.
  Historically this was described as a "tongue-like" spread: the redness extends along certain lymphatic channels, with a narrower leading edge that widens toward the lower end.
• Swelling: The skin in the affected area swells and feels tight. This swelling can also be noticeable around the infected region.
• Warmth and pain: The skin may feel warm, and there can be tenderness and pain. The intensity of pain varies and may increase with pressure or touch.
• Fever and general symptoms: Erysipelas is often accompanied by fever, which can be mild or high. Other general symptoms may include chills, headache, fatigue and muscle aches.
• Blisters or pustules: Small blisters may appear on the inflamed area containing clear fluid (lymph) or pus.
• Regional lymph node swelling: If the infection reaches nearby lymph nodes, they may become enlarged, tender and painful.

Complications of erysipelas

Neglected erysipelas can lead to serious complications!

Sepsis (blood poisoning): Without treatment, or if the wrong antibiotic is given, bacteria can enter the bloodstream and cause severe sepsis, which can be life-threatening.

Skin problems: After erysipelas, residual changes such as discoloration, spots or scarring can remain on the skin.

Lymphoedema (also called lymphedema): As mentioned, the pathogens that cause erysipelas spread and cause inflammation in the lymphatic vessels. Scarring from this inflammation can damage, block or obstruct the lymphatics. Even a single episode of erysipelas can result in permanent lymphoedema. Recurrent erysipelas makes this outcome almost certain.

The lymphatic system's job is to remove lymph from tissues. Small lymphatic vessels collect it and pass it to larger vessels that lead to lymph nodes. Lymph nodes filter the lymph and remove cells and substances important for immunity. If inflammation from erysipelas destroys lymphatic vessels, the lymphatic system can no longer function normally, leading to edema (swelling).

Lymphoedema resulting from erysipelas is a permanent, incurable condition.

What to do if you suspect erysipelas

See a doctor immediately (start with your GP, or a dermatologist). The sooner appropriate antibiotic treatment begins, the lower the risk of complications.

Erysipelas CANNOT be treated at home with folk remedies, soaking, nettle tea, or ointments!

If symptoms appear, avoid exertion. Even muscle movement from walking can promote the spread of the infection.

Do not squeeze, massage or scratch the affected area, as this can rupture and spread the infection.

Keep the affected area clean and dry.

Do not apply anything or rub the area! Wet dressings further soften the skin and help bacteria spread.

Cool the area! Dry cooling (not wet compresses) reduces inflammation and lowers skin temperature, which is unfavorable for bacterial growth and slows the spread of infection. By dry cooling, I mean using a cold pack or even a bag of frozen peas, but do not place it directly on the skin — put a layer of towel between the skin and the cold source. This prevents the skin from getting wet while allowing the beneficial cooling effect.

Cooling sessions should last 10–15 minutes at a time. Prolonged cooling can cause frostbite-type skin injury.

Do not let others touch the wound with bare hands. If they do, they should immediately wash their hands with soap and warm water and use a hand disinfectant, e.g. a household bleach solution.

Recovery time for erysipelas

With appropriate treatment, erysipelas generally heals in 1–2 weeks, but this depends on several factors.

When you start taking antibiotics — the main therapeutic method — you may feel symptom relief within 2–3 days. Fever and malaise usually resolve within the first 48 hours, while the red, swollen area on the skin begins to fade within 7–10 days.

To ensure full recovery, be sure to follow these important rules.

• Take the antibiotic prescribed by your doctor exactly as instructed.
• It is important to take the tablet at the same time each day to maintain an even blood level of the medication.
• Finish the full prescribed course even if you feel better!
• Rest a lot, especially during the first days, because your immune system works best when rested.
• Keep the infected area clean and dry! Do not apply wet dressings or soak it.
• If you have fever or pain, take antipyretics or pain relievers.

Contact a doctor if symptoms do not begin to improve after 3 days of correctly taken medication, or if new symptoms appear. Also seek medical help if the redness continues to spread or if your fever does not subside.

Because erysipelas tends to recur, pay attention to prevention even after complete recovery. Protect the skin from injury and promptly treat even minor wounds.

Learn more about lymphoedema and treatment options