Erysipelas therapy

The most important rule for preventing erysipelas is good skin protection and special hygiene in the affected areas, especially areas with lymphatic vesicles on the skin or lymphangioma circumscriptum in the case of lymphatic malformation.

Most erysipelas occur in patients with lymphatic malformations and primary lymphedema, usually in connection with small skin defects or lymphorrhea and small cutaneous lymphatic vesicles.

In most cases the source is a streptococcal infection of lymphatic tissue of the skin and subcutaneous tissue, which spreads rapidly in the lymph vessel system.

These streptococci are usually sensitive to penicillin. If there are local signs of inflammation (increased temperature, extensive reddening of the skin, local pain, burning sensation) and systemic signs of infection such as fever, penicillin may have to be administered intravenously, otherwise it can also be given orally. Inpatient treatment is often necessary to avoid progression into sepsis. Therefore, it is essential to consult a physician early if there are signs of erysipelas.

If there are more than 3 erysipelas per year or recurrent severe erysipelas and the source cannot be treated successfully, erysipelas drug prophylaxis, e.g., with oral penicillin, is indicated.

So-called “pulsed prophylaxis” (2 x daily oral penicillin every 3rd or 4th day for 6 months) is often clinically adequate and is better tolerated than daily administration. Alternatively, an intramuscular depot penicillin (e.g. benzylpenicillin benzathine) every 6 to 8 weeks may be prescribed.

In the case of recurrent erysipelas under prophylaxis, an antibiogram is required to exclude bacterial antibiotic resistance. This may necessitate a change of the antibiotic regimen based on the antibiogram (usually broad-spectrum penicillin, ciprofloxacin, clindamycin, etc.).