Introduction to erysipelas Ericsipelas is an infection involving the superficial lymphatic vessels of the dermis. The main pathogen is group A -hemolytic streptococcus. The predisposing factors are the surgical wound or the nostril, the external auditory canal, the underside of the earlobe, the anus, the fissure between the penis and the toe. Any inflammation of the skin, especially inflammation with cleft palate or ulceration, provides an invasive route for pathogenic bacteria. Mild abrasions or scratches, injuries outside the head, unclean umbilical cord ligation, vaccination, and chronic leg ulcers can all cause the disease. basic knowledge The proportion of sickness: 0.01% Susceptible people: no special people Mode of infection: non-infectious Complications: sepsis


Cause of erysipelas

Infection (35%):

The disease is caused by the invasion of group A B-type hemolytic streptococcus. The main factors are skin or mucosal abrasions or other minor trauma, which can also be caused by blood infection, often secondary to rhinitis, oral mucosa and tooth infection. Athlete's foot, leg ulcer, itching skin disease, inoculation, radiation damage and skin splitting or slight rubbing, scratching and minor trauma can be induced, especially unclean wounds are more susceptible to infection, some wounds can be small enough to be found, such as Facial erysipelas can be caused by small wounds that are scratched in the nasal cavity. Recurrent erysipelas is caused by bacteria lurking in the lymphatic vessels, and when the body's resistance is reduced, it can recur.

Reduced immune function (25%):

The disease occurs when the body's immune function is reduced. Systemic diseases such as diabetes, chronic nephritis, hypogammaglobulinemia, and alcohol abuse can all be the cause of the disease. Infants with erysipelas can cause sepsis and have a high mortality rate.

Other factors (25%):

Others such as malnutrition, excessive alcohol abuse, gamma globulin deficiency and renal edema can be the triggering factors for erysipelas.


Erysipelas prevention

Actively prevent and treat athlete's foot, prevent calf erysipelas, avoid and correct the habit of digging nose to prevent facial erysipelas. Should actively look for skin lesions such as eczema that can cause pathogenic bacteria to enter, scratch, damage or trauma, once found that these skin lesions should be actively treated. The most common, easily overlooked and untreated factor is the athlete's foot, which can become a gateway for bacteria to enter the skin.


Arsenic complications Complications sepsis

The disease is generally self-healing, less concurrent with other diseases, infants and elderly frail patients, such as treatment is not timely, often can occur nephritis, subcutaneous abscess and sepsis and other complications.


Symptoms of erysipelas common symptoms erysipelas-like appearance sepsis peritonitis necrotizing fasciitis erysipelas low fever nausea aversion cold high fever

Before the onset, there are often active period of athlete's foot, nose, oral infection and skin trauma history. Before the appearance of skin lesions, there are often systemic symptoms such as aversion to cold, fever, headache, nausea and vomiting. Infants sometimes have convulsions, and the incubation period is generally 2 ~5 days.

The rash begins to be red and swollen and hard, and then spreads rapidly to the surrounding area and becomes a large piece of scarlet plaque damage. The surface is hot and shiny, slightly elevated, and the boundary is clear. Afterwards, the skin lesions are extended outward, and the central red color is reduced. Brownish yellow with slight desquamation and tenderness. It is called blister or erysipelas vesiculosum or erysipelas bullosum when there are blisters or bullae in the skin lesions. When the symptoms are extremely serious, the affected part can Rapid occurrence of gangrene becomes erysipelas gangrenosum. This condition is more common in newborns, mostly starting from the umbilical or genital area, and then rapidly expanding, the condition is dangerous, easy to cause sepsis and peritonitis and even death.

Damage can also spread to other places (walking erysipelas) or repeated occurrences in the primary lesions (recurrent erysipelas), multiple relapses are called chronic recurrent erysipelas, localized often secondary to lymphedema, can occur in any part The calf, face, forearm, hand, foot and baby's abdomen are more common, other parts can also occur, local lymph nodes are swollen, can occur throughout the year, but common in spring and autumn.

1. Mainly based on rapid onset, local redness and swelling, clear boundary, accompanied by high fever and pain, etc., easier to diagnose.

2. Chinese medicine pathogenesis and syndrome differentiation

(1) Pathogenesis: This disease is caused by blood and heat, fire poison invades the skin, or dampness and heat, caused by exogenous poisonous evils. Most of the people who are on the head and face are hot and poisonous, and those who are in the lower limbs are mostly hot and humid.

(2) syndrome differentiation: wind heat syndrome: local skin redness and fever, severe pain, clear boundary, aversion to cold with high fever, headache, thirst, upset, urinary red, dry, red tongue, moss Yellow or thick, pulse floating number,

(3) Damp heat syndrome: local skin redness and swelling, the border is still clear, the surface may have blisters, blood blisters, with aversion to cold, low fever, thirst for not drinking, loss of appetite, red tongue, yellow and white moss, slippery number.



Blood routine examination showed a total number of white blood cells or neutrophils, accelerated erythrocyte sedimentation rate, and increased resistance to streptococcal hemolysin.

Histopathology: high edema of the dermis, expansion of capillaries and lymphatic vessels, swelling of connective tissue, swelling of endothelial cells in the middle and small arteries, fibrin embolization in the lumen, diffuse inflammatory cell infiltration in the dermis and dilated lymphatic vessels (in the middle) Sclerotia is the main), sometimes streptococci can be seen, and edema or bullae can be seen in the epidermis.


Diagnosis and identification of erysipelas

The disease must be differentiated from contact dermatitis, cellulitis, polymorphous sun rash, angioedema and other diseases.

1. Contact dermatitis has a history of contact, local redness, unclear borders, itching, rashes, papules, blisters, bullae, erosion, exudation, scarring, etc., white blood cell count does not increase.

2. The pathogenesis of cellulitis is deep, the subcutaneous tissue is inflamed, the affected area is tender and slightly red and swollen, the boundary is not obvious, the inflammation spreads rapidly and aggravates, and the central inflammation is obvious, there is significant acupressure edema, and then becomes soft. Broken pus and exclude pus and necrotic tissue.

3. Polymorphous sun rash is a polymorphic rash that occurs on the face and exposed parts. It is damaged by erythema, telangiectasia, edematous erythema, maculopapular rash, herpes and blister or mossy polymorphic rash.

4. Angioedema is a temporary, localized, painless subcutaneous or submucosal edema, which occurs in areas where the tissue is loose and easily swollen, such as the eyelids, lips, earlobe, external genitalia, and throat.

5. The sputum rash is caused by sputum rash in the calf. It is often erythematous, and the edema is not obvious. The symptoms of the athlete's foot are relieved or cured and the symptoms disappear.

Category 6 erysipelas has a history of injury in contact with livestock, fish or slaughter. The damage usually occurs in the hands of purple-red, no purulent, not easy to blisters, often without obvious systemic symptoms, and the porcine bacillus culture and inoculation test is positive.

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