Erysipelas: complications, risk factors, management

Rugilė Mikalčiutė-Ramanauskienė1

1Vilnius University Faculty of Medicine


Erysipelas is an infectious disease that affects dermis and subcutaneous layer of the skin. Most infections are due to streptococcus while S.aureus, gram-negative pathogens or enterococcus are less common. One in three patients have complicated erysipelas. The most common local complications: abscesses, skin necrosis, bullae, thrombophlebitis. Meanwhile systemic complications are rare. Secondary to infection, elephantiasis and necrotiziing fasciitis can occur. A long lasting and challenging complication is recurrence of the disease. Aim: To analyze complications, risk factors, treatment options of erysipelas in literature.

Methods: Literature search was performed using Pubmed and ClinicalKey databases. 27 articles related to the topic of this work were selected and analyzed.

In case of frequent episodes of erysipelas, prophylactic antibiotic therapy and avoidance of risk factors are recommended. Literature review has shown that erysipelas complications are associated with patients‘ comorbidities, delayed or incorrect treatment of skin wounds and infections, lifestyle factors. Diabetetes mellitus, immunosuppresion, lymphedema, deep vein thrombosis, malignancies, hepatic, renal, heart diseases, elephanthiasis, smoking, alcoholism, lack of hygiene – all increase the likelihood of complicated erysipelas. Obesity is thought to be the most important risk factor for complicated erysipelas. Delayed or incorrect empirical treatment, increased inflammatory test results are all associated with more severe disease progression. Complicated erysipelas can cause worse disease outcomes, prolong hospitalization and antibioticotherapy time. Therefore, it is important to start penicillin monotherapy in time before complications occur and if there is no response to treatment adjust antibiotic therapy according to the culture results, if needed use invasive treatment methods.

Keywords: Erysipelas, cellulitis, complications, risk factors, treatment.