Erysipelas

Disease Description (Causes and Symptoms)

• Definition: Erysipelas (단독) is an acute bacterial skin infection in which acute inflammation develops in the upper dermis and superficial subcutaneous tissue, mainly due to invasion by group A streptococci (or other streptococci), causing well-demarcated redness and swelling.
• Pathophysiology: Bacteria penetrate the dermis through damage to the skin barrier (microfissures, eczema, ulcers, surgical wounds, etc.), causing inflammation in the superficial lymphatic vessels and dermis. Recurrent infections may cause chronic lymphedema due to lymphatic vessel damage.
• Main symptoms: Sudden fever, chills, and generalized malaise; locally, clearly demarcated, flat areas with marked erythema, swelling, warmth, and tenderness. In severe cases, blisters, petechial hemorrhage, and necrotic findings may occur. It most commonly affects the face (possibly in a butterfly-like pattern), legs (especially the lower legs), and arms.

Treatment Methods

• Basic principles: Prompt antibiotic treatment (oral or intravenous) + local supportive care (rest, elevation of the affected limb, maintaining hydration, and pain control).
• Standard medications (examples):
  • Mild cases (outpatient): Oral penicillins (phenoxymethylpenicillin/penicillin V) or amoxicillin. Alternatives: clindamycin or macrolides (in cases of penicillin allergy). Generally 7–10 days (may be shortened if there is clinical improvement).
  • Severe cases/systemic symptoms or malabsorption: Hospitalization and intravenous penicillin (benzylpenicillin/penicillin G).
  • Penicillin hypersensitivity: Consider clindamycin or macrolides such as erythromycin.
• Treatment duration and switching: Switching to oral treatment is possible after clinical improvement (resolution of fever and reduction of redness). The total treatment duration is usually 5–14 days and may be extended in recurrent cases or when improvement is slow.
• Prevention (when recurrences are frequent): Consider low-dose repeated prophylaxis (regular benzathine penicillin injections or long-term low-dose oral antibiotics under medical judgment).
• Adjunctive treatment and self-care: Elevate the infected area, provide appropriate wound care, manage underlying conditions such as diabetes, and use analgesics/antipyretics for pain or fever.
• Contraindications and precautions: In cases involving lower-limb swelling or ulcers, differential diagnosis of conditions such as thrombophlebitis is necessary. Check for a history of allergies before administering antibiotics.

Checkpoints Before an Outpatient Visit (Including Example Questions)

Items/documents to prepare:

• A list of currently used medications (including prescription and nonprescription medicines and supplements) and a history of allergies (especially to antibiotics such as penicillin)
• A history of previous erysipelas (단독) episodes and frequency of recurrence, and whether there has been previous surgery, lower-extremity varicose veins, or lymphedema
• A history of diabetes, alcohol use disorder, or immunosuppression (such as steroid use or anticancer treatment)
• Whether there have recently been wounds, animal bites, or skin conditions (such as athlete’s foot or eczema)
• When the symptoms began, the pattern of fever, and whether the symptoms have worsened (taking photographs and submitting them may help with diagnosis)
• Bring any recent test results (such as blood glucose, CRP, and WBC) or hospitalization records if available

Example questions (useful to write down before the outpatient visit):

• "When did the symptoms begin, and how quickly did the redness spread?"
• "Have you recently taken steroids or immunosuppressants?"

General Examples of Questions to Ask the Doctor

• "What are the possible side effects of this medication (the prescribed antibiotic), and what symptoms would require me to stop taking it immediately?"
• "What is the expected treatment duration and recovery speed? When can I return to my daily activities?"
• "What lifestyle habits or skin care (e.g., moisturizing and toenail care) should I follow to prevent recurrence?"
• "How would the treatment plan or prognosis differ if I have diabetes or lymphedema?"

Examples of Condition-Specific Questions

• "My erysipelas keeps recurring. Should I start preventive antibiotics (regular injections or long-term oral treatment)? What are the advantages and disadvantages?"
• "Erysipelas on my face has spread to my nose and both cheeks. What tests are needed to assess the risk of systemic complications such as chest complications and endocarditis?"

Additional Points to Note (Summary)

• If the condition worsens rapidly or there is high fever, difficulty breathing, decreased consciousness, or rapid expansion of the lesion, a visit to the emergency room is necessary.
• In cases of recurrent infection, assess for lymphedema, venous disease, and underlying immune status and establish a strategy to prevent recurrence.