Erysipelas, also called St. Anthony's fire, is caused by infection by Group A Streptococci. This same type of bacteria is responsible for such infections as strep throat, and infections of both surgical and other kinds of wounds in the skin. The infection occurs most often in young infants and the elderly.
Causes and symptoms
Erysipelas usually occurs rather abruptly. When the preceding infection was strep throat, the rash begins on the face. Occasionally, when the preceding infection was of a wound from an injury or operation, the rash will appear on an arm or leg.
Classically, the usual presentation is a bright-red, butterfly-shaped rash appearing across the bridge of the nose and the cheeks. It is hot to the touch, painful, shiny, and swollen, with clearly defined margins. The edges of the rash are a raised ridge, hard to the touch. There may be fluid-filled bumps scattered along the area. The rash spreads rapidly. Some patients have swelling of the eyelids, sometimes so severe that their eyes swell shut. The patient may have fever, chills, loss of energy, nausea and vomiting, and swollen, tender lymph nodes. In severe cases, walled-off areas of pus (abscesses) may develop beneath the skin. If left untreated, the streptococcal bacteria may begin circulating in the bloodstream (a condition called bacteremia). A patient may then develop an overwhelming, systemic infection called sepsis, with a high risk of death.
Rosalyn Carson-DeWitt MD, The Gale Group Inc., Gale, Detroit,