erysipelas or superficial subcutaneous tissue (Erysipelas, St. Anthony’s fire) is a skin infection characterized by a bright red rash. spreading rapidly like a field fire It is an inflammation of the dermis (Dermis) and superficial subcutaneous tissue (Upper subcutaneous tissue), including nearby lymphatic vessels. which is caused by infection with streptococcus group A bacteria (Streptococcus) and other streptococcus groups
This disease is often found in people with low immunity, such as in young children, the elderly, people with diabetes, etc. The severity of the symptoms can vary greatly. Since it is not much cured by taking antibiotics and taking care of yourself. to symptoms that are spreading to high fever and infection in the bloodstream
Causes of erysipelas
Most of them are caused by bacteria known as “Betahemolotic streptococcus group A” (group A beta-hemolytic streptococcus (GABHS), also known as “Streptococcus Piogenus(Streptococcus pyogenes) and may be caused by other groups of streptococcus. or other bacteria The infection may enter the skin through abrasions or wounds (such as abrasions, cuts, scrapes, insect bites, surgical wounds), fissures of the skin caused by injuries or wounds that we sometimes have. may not be noticed, fissures of the skin caused by fungal infections, areas with existing necrosis (eg diabetic foot ulcers), chronically swollen areas (eg, swollen hands, feet, arms, legs), etc., which when The disease enters the dermis and will cause further infection. But there are times when these skin cracks are gone when erysipelas develop.
People with risk factors for erysipelas
- People with low immunity, such as infants, young children, the elderly, people who use certain drugs. (especially immunosuppressive drugs steroid drugs), alcoholism patients, cancer patients, patients with underlying medical conditions (such as diabetic patients), etc.
- Patients with venous thromboembolism or clogged lymphatic ducts (eg, swollen arms from radiotherapy) and/or from breast cancer surgery) or has chronic swelling or necrosis
- People who have had vein surgery in the leg (eg varicose veins disease), pelvic surgery (eg cervical cancer surgery), or inguinal lymph node surgery (eg in patients with skin cancer of the leg).
Symptoms of erysipelas
Symptoms often occur acutely. The affected skin is characterized by a large, bright red rash, pain, swelling, and heat. When touched on the back of the hand, it appears hotter than normal skin. Later, the rash spreads and spreads around rapidly like erysipelas. The skin in that area is convex, clearly separated from normal skin. (Skin is swollen, stiff) and looks like an orange peel or pig’s skin (Peau d’ orange). If you press on that area, the color will fade and there is a slight dent. In the later stages, the rash subsides and gradually fades, and the skin may flake. And it will take about 2-3 weeks for the rash to disappear completely. without causing scars (This rapidly spreading red rash caused by the toxic effects of pathogens not caused by the pathogen directly. Even if the pathogen is eliminated through the use of medicines. But the residual venom can continue to spread the rash. Hence the origin of the name.erysipelas“)
In addition, there are also symptoms that are often found in conjunction with fever that often occurs suddenly and in severe cases, there are often high fever, chills, headache, loss of appetite and fatigue. This usually occurs within 48 hours of infection (wound).
In some cases, red streaks may appear due to inflammation of the lymphatic ducts. before the spreading red rash and may find nearby lymph nodes swollen and painful. In severe cases, there may be blisters (Blister) as well as greasy fluid. But usually not thick pus. (If it is purulent, it is usually caused by inflamed deep subcutaneous tissue.)
About 90% of erysipelas patients The rash is usually caused by an infection on the legs and feet. The remaining 2.5-10% may be found on the face. (It can be on one cheek or both), around the eyes, around the ears, arms, fingers, or toes.
However, in patients with low immunity have congenital disease with swelling (eg chronic leg swelling) or lymphatic duct abnormality There is often a recurrence in the same location in about 16-30%. If the disease is frequent, it can cause permanent swelling of the lymphatic ducts and swelling of the arms and legs. If it is on the legs or feet, the skin in that area will look rough.
Complications of erysipelas
- if left untreated or treated too late The infection may spread into the bloodstream and cause septicemia. which if found in young children, the elderly, people with diabetes or in people with low immunity It can be dangerous to death.
- In some cases, the infection may spread to the heart to become endocarditis, spread to the joints to become purulent arthritis, and spread into the lymphatic system to lymph nodes such as inguinal lymph nodes. Until those lymph nodes become inflamed, swollen and painful.
- skin infection if severe May cause purulent wounds and inflamed blood vessels.
- In children under 10 years of age, acute glomerulonephritis may develop, causing high fever, swelling of the body, and reddish-colored urine.
Diagnosis of erysipelas
In case of mild symptoms A doctor can diagnose erysipelas based on the symptoms. physical examination Examination of the appearance of the rash and from various medical histories, in which patients often have a history of wounds on the skin in the area where erysipelas occur before But in some people may not have such a clear history. The lesions that are found are red, hot, painful, swollen, rapidly spreading, and have clear edges. In cases where it is uncertain or if the patient has severe symptoms, bacterial cultures from the wound and blood may be required. to be used to identify the type of bacteria There may also be a CBC (CBC) blood test to find high white blood cells. Leukocytosis, which will help tell if there is a bacterial infection in the body.
It can be caused by other causes (not erysipelas). The most common include:
- inflamed deep subcutaneous tissue (Cellulitis) with the same cause and symptoms as erysipelas but will eat deeper into the deeper layers of subcutaneous tissue But the rash has an unclear edge like erysipelas. and may be found as pus or the skin becomes necrotic as well
- urticaria (Urticaria) The rash is red and itchy, but does not feel pain and appears all over the body. It happens suddenly after an allergic reaction. And patients usually do not have a fever like erysipelas.
- shingles (Herpes zoster) patients will have a red rash. have a burning pain and there are blisters arranged in a longitudinal line along the nerve This usually occurs only on one side of the face, ribcage, upper arm, or leg. and symptoms will subside within 2-3 hours
- gout (Gout) The patient will have joint pain. red, swollen joints It’s usually just one of the big toe or ankle joints. Patients may also have a fever. Symptoms of this disease usually occur after feeding. drink alcohol or eating foods high in uric acid
How to treat erysipelas
- Patients should act on the advice of a physician. especially in the care of wounds or rashes This includes maintaining basic hygiene to help keep the body healthy and reduce the severity of the disease. and visit the doctor at regular appointments
- The doctor will advise the patient to rest a lot, trying not to move the inflamed area. walk less The inflamed arm or leg should be raised above the heart level to reduce pain and swelling. If there is severe swelling or pain, apply a cold compress 4 times a day for 48 hours to help the swelling of the rash disappear faster. And in some cases, an elastic bandage may be required, depending on the doctor’s recommendation. But if there is pain or fever Take a pain reliever and fever reducer like paracetamol. or if eating or drinking is low, intravenous fluids may be required. (Patients can eat normally because there is no slang food for this disease But should focus on eating protein foods such as meat, milk, eggs as much)
- in patients with mild symptoms It can be treated by taking antibiotics to kill bacteria and outpatient treatment. Your doctor will prescribe antibiotics such as penicillin V, erythromycin. (Erythromycin), Coamoxiclav (Co-amoxiclav), etc. The duration of antibiotic therapy is generally about 2 weeks. Patients must take the antibiotic prescribed by the doctor completely and correctly, do not stop taking the medication when symptoms improve or resort to treatment. other treatments (such as herbal remedies) and must be finished with all medications prescribed by your doctor. In general, if treated properly in the first place Symptoms usually subside within 24-72 hours, i.e. the fever decreases, the pain or heat of the rash decreases. The rash may continue to spread, but will subside or disappear within a few weeks of receiving antibiotics. However, the lesion part of the skin may flake off without causing any scarring. in those who received the correct treatment too late or who had low immunity It can cause serious and dangerous complications.
- In cases where the symptoms have not improved within 3-5 days or have severe symptoms The rash continues to spread or the fever persists. Or found in people with diabetes or people with low immunity. or suspected complication of septicemia Should see a doctor before the appointment to assess the symptoms. In severe cases, your doctor will be hospitalized and administer an antibiotic such as Penicillin V in a dose of 1-2 million units intravenously every four to six hours until symptoms subside. therefore gradually switched to oral antibiotics
- Herbal treatment for erysipelas There are many types. But this method is not recommended until after a diagnosis and advice from a doctor. (Articles from the herbal database on the website) are:
- Esldpagpon male (Barleria lupulina Lindl.) or Esldpagpon female (Clinacanthus nutans (Burm.f.) Lindau) Take 5-10 fresh leaves to crush or pound and apply to the affected area.
- water acid (Scoparia dulcis Linn.) The whole plant has properties as a remedy against erysipelas or virus on the skin. (does not specify how to use)
- eaglewood (Aquilaria crassna Pierre ex Lecomte) in the Bible Mention Agarwood that has properties to help nourish the blood. Cure Blood Bihar Helps to treat tooth disease, erysipelas (not specifying the part used and how to use it)
- herringbone (Phyllanthus reticulatus Poir.) Apply rain roots to the affected area.
- death in law (Glycosmis pentaphylla (Retz.) DC.) Use fresh leaves to crush or grind mixed with white liquor or alcohol or lemon juice. Used as a topical treatment for erysipelas.
- Charlie’s Swing (Tinospora baenzigeri Forman) Use young leaves mixed with milk to cure erysipelas.
- White Jade Mun Ploeng (Plumbago zeylanica L.) Use fresh leaves to be pounded and wrapped in gauze. Use the mask on the affected area until it disappears.
- Ring Rake (Acmella oleracea (L.) RKJansen) The leaves and stems are pounded thoroughly and mixed with liquor. Use to eat 1 time per day. The salt residue can be used to mask the affected area throughout the day.
- coriander (Coriandrum sativum L.) Use fresh stalks to be cut into pieces, put into the liquor and bring to a boil. Used to paint the area
- big pear (Portulaca oleracea L.) Use fresh leaves to mask the affected area.
- Gotu Kola (Centella asiatica (L.) Urb.) is used as a poultice to treat heat swelling of erysipelas.
- Phaya Thao Waist (Oxyceros bispinosus (Griff.) Tirveng.) Use the stems to bring rain and lime water to be eaten as erysipelas.
- Liu (Salix babylonica L.) Use dry branches to burn to ashes. Then mix the water as a topical treatment for the affected area.
- elephant trunk grass (Heliotropium indicum L.) This herb in India, in addition to being used as a remedy for skin diseases. It is also used as a remedy for insect bites. Cure ringworm and erysipelas (not specifying the part used)
- Mahakan (Gynura pseudochina (L.) DC.) The whole plant is used as a cure for erysipelas. (does not specify how to use)
- Mok Luang (Holarrhena pubescens Wall. ex G.Don) The seeds are used as a remedy for erysipelas. (does not specify how to use)
- calabash (Lagenaria siceraria (Molina) Standl.) leaves are used as a remedy for erysipelas. (does not specify how to use)
How to prevent erysipelas
- It should be noted and be careful not to cause skin wounds that are a path for bacteria. Especially in people with risk factors for bacterial infections that easily lead to erysipelas.
- If a wound develops, promptly clean it by washing the wound with soapy water and applying antibiotic ointment. If the wound does not improve within 2-3 days after taking care of yourself, you should see a doctor.
- If skin inflammation is found It is a red, hot, painful rash with clear edges. or looks like a red line and/or accompanied by fever to suspect that it is a symptom of erysipelas Especially in the legs and feet that are common, patients should seek medical attention for early diagnosis and treatment. Because if left or a person with low immunity to disease, such as young children, the elderly, people who take immunosuppressant drugs People with congenital diseases, etc., can cause serious to dangerous complications.
- Textbook of general medical examination 2. “erysipelas (Erysipelas)”. (Dr. Surakiat power Pages 991-992.
- Find a doctor. com.”erysipelas (Erysipelas)”. (Dr. Chonthirot Srikasetsarakul). [ออนไลน์]. Accessed from: haamor.com. [26 เม.ย. 2016].
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