Erysipelas Leg Pictures - 28 Photos & Images

Erysipelas is often of sudden onset, marked by frank systemic signs—fever >38°5, chills—and general malaise. Patients with lymphedema, who present with recurrent episodes of erysipelas, often recognize these inaugural signs. Local signs develop within a few hours: a red, warm, painful, inflammatory spreading lesion, with centrifugal extension within a few days. Erysipelas can start at any point of lymphedema and can extend to all or part of the lymphedematous cutaneous tissue, in an anterograde or retrograde pattern. Inflammatory, satellite adenopathy and lymphangitis are associated with erysipelas in 25% to 50% of cases.

In the case of erysipelas complicating lymphedema, the clinical presentation is more serious. Statistically significant differences (P<0.05) were seen between 20 controls with erysipelas but without lymphedema and 10 age- and sex-matched patients with lymphedema hospitalized for erysipelas: prolonged persistence of fever, more frequent tachycardia, delayed recovery, and positive blood cultures (30% vs 0%).

The diagnosis of erysipelas is clinical: sudden occurrence of an inflammatory lesion that spreads within a few days, preceded by or concomitant with fever and chills, and general malaise. No bacterium other than ß-hemolytic streptococcus has been demonstrated as responsible for erysipelas. Streptococcus was isolated 15 times more often in lymphedema with an infectious complication than outside any acute inflammatory episode, and serology testing for streptococcus (ASLO) was more often positive in patients with lymphedema (78%) than in a healthy control population (46%). Bacteriological samples are positive in erysipelas in only 4% to 35% of cases with standard methods. Using the most sophisticated methods (immunofluorescence, polymerase chain reaction), streptococcus is isolated at a frequency of 70% to 80%.5 Other bacteria (Staphylococcus aureus, Enterobacteriaceae, Pseudomonas) have been isolated alone or in combination with streptococcus. But to date a causal relationship has never been demonstrated.

Furthermore, these bacteria are commonly found on skin and colonize wounds, and their isolation from samples collected from the skin is difficult to interpret. Laboratory tests are not helpful in establishing the diagnosis: the complete blood count shows leukocytosis in one-half of cases, and a nonspecific inflammatory syndrome is indicated by laboratory findings in two-thirds of cases.