Update: December 2018
Erysipelas (or simply erysipelas) is one of the bacterial
skin infections that can affect any part of it and lead to
the development of severe intoxication. The disease flows in stages
because of which the mild form, which does not violate the quality of life, can
go into heavy. Prolonged erysipelas without proper
treatment will eventually lead to the death of the affected skin and
the suffering of the whole organism.
ATажно, чтобы при наличии характерных симптомов рожи больной
turned to the doctor, and was not treated on their own, waiting
disease progression and the development of complications.
In order for erysipelas to occur, the observance of three
- The presence of a wound – so that bacteria penetrate the skin is not necessary
have extensive soft tissue damage. Enough scratches
�”Cracking” of the skin of the feet or a small cut;
- Byпадание в рану определенного микроба – считается, что
erythema can only cause hemolytic streptococcus
А. Byмимо местного повреждения кожи, он вырабатывает сильные
toxins and disrupts immunity. This is manifested by intoxication.
the body and the possibility of faces recur (reappear,
after a certain time);
- Weakened immunity – this factor is important for
development of skin infections. Erysipelas practically none
occurs in healthy people whose immunity is not weakened by another
disease or harmful living conditions (stress,
physical / mental overload, smoking, drug addiction,
Although the disease may occur in each
human, under the above conditions, suffer predominantly
people of old age. Also at risk are babies,
больные сахарным диабетом, ATИЧ, любой онкологической патологией или
receiving glucocorticosteroids / cytostatics.
What is erysipelas
There are several forms of erysipelas that
differ in the severity of symptoms, severity and tactics of treatment.
Should отметить, что они могут последовательно переходить одна в
another, therefore, it is important to start treatment promptly.
Withнципиально следует разделять
The following forms of the disease:
- Erythematous erysipelas – manifested by classic symptoms, without
any additional skin changes;
- Bullous form – characterized by the formation of blisters on the skin
with serous contents;
- Hemorrhagic (bullous-hemorrhagic) is a feature of this
the kind of erysipelas is caused by infection of the small blood vessels
vessels. Because of this, the blood flows through their wall and forms
bubbles with hemorrhagic content;
- Necrotic – the most severe form in which occurs
necrosis of the affected skin.
AT зависимости от расположения, рожа может быть на лице, ноге,
arm. Much less often an infection forms in the perineal region.
or on other parts of the body.
The onset of erysipelas
From the moment the wound is infected until the first symptoms appear,
on average, it takes 3-5 days. Symptoms of erysipelas
faces, hands, feet and any other localization begin with lifting
fever and tenderness of the affected area. As a rule, in
первый день болезни наблюдается лихорадка не более 38оС.
AT дальнейшем температура тела может подниматься до 40оС.
Due to the action of streptococcus, the patient has all the characteristic
signs of intoxication:
- ATыраженная слабость;
- Decrease / loss of appetite;
- Byвышенная потливость;
- Byвышенная чувствительность к яркому свету и раздражающему
A few hours after the temperature rises (up to 12 hours)
Symptoms of skin lesions and lymphatic structures appear. They
somewhat different depending on the location but their
combines one feature – it is pronounced redness of the skin. Erysipelas can
spread beyond the affected area or remain
only in one area. It depends on the aggressiveness of the microbe,
body resistance to infection and the time of initiation of therapy.
Local symptoms of erysipelas
Common signs of erysipelas on the skin are:
- Severe redness of the affected area (erythema), which
rises somewhat above the surface of the skin. From healthy tissue
erythema is delimited by a dense roller, but with widespread
his face may not be;
- Pain when palpating a redness area;
- Swelling of the affected area (foot, leg, face, forearm, and
- Soreness of lymph nodes, next to the focus of infection
- With буллезной форме, возможно появление прозрачных пузырей на
skin filled with blood or serous fluid (plasma).
Byмимо общих признаков, рожа имеет свои особенности при
localization in different parts of the body. They need to be considered to
time to suspect infection and start treatment in a timely manner.
Features of erysipelas of facial skin
The face is the most unfavorable localization of the infection. This
body area is very well supplied with blood, which contributes
development of marked edema. Lymphatic and blood vessels
connect the superficial and deep structures because of what is
the likelihood of purulent meningitis. Skin is enough
tender, therefore, it is damaged by infection somewhat stronger than with
Given these factors, it is possible to determine the features of the symptoms.
erysipelas of the face:
- Soreness of the infected area increases with chewing
(if the erysipelas is located in the lower jaw or on the surface
- ATыраженный отек не только покрасневшего участка, но и
surrounding facial tissues;
- Soreness when probing the side surfaces of the neck and under
chin – a sign of inflammation of the lymph nodes;
Symptoms of intoxication upon infection of the skin of the face are pronounced.
сильнее, чем при other locations. AT первые сутки, температура
тела может возрасти до 39-40оС, появиться выраженная
weakness, nausea, severe headache, and sweating. Erysipelas
inflammation of the face is a reason to immediately consult a doctor or
in the emergency room of the surgical hospital.
Features of erysipelas on foot
There is a conviction among doctors that erysipelas
lower extremity is closely related to the violation of the rules of personal hygiene.
Lack of regular foot washing creates excellent conditions for
breeding streptococci. AT этом случае, для их проникновения в
one microtrauma is enough for the skin (cracks in the feet, small
scratch or puncture).
Features of the clinical picture of erysipelas in the legs
- The infection is located on the foot or lower leg. Hip amazed
- As a rule, in области паховых складок (на передней поверхности
body, where the thigh enters the body) painful
round formations are inflamed inguinal lymph nodes,
which inhibit the spread of streptococcal infection;
- With выраженном лимфостазе, отек ноги может быть достаточно
strong and spread to the foot, the ankle area
and shin. Detect it easily enough – you need to
finger press skin to the bones of the leg. If a имеется отек, то после
the finger will be removed for 5-10 seconds.
AT большинстве случаев, рожистое воспаление нижних конечностей
proceeds much easier than with a different location of the infection.
An exception составляют некротическая и осложненная формы.
Features of erysipelas on hand
Streptococcal infection affects the skin of the hands quite rarely, so
as a large concentration of germs around the wound create enough
difficult. Erysipelas on the upper limb may be due to a puncture.
or cut by a contaminated object. Children are at risk
preschool and school ages, intravenous drug addicts.
Erysipelas воспаление на руке чаще всего распространенное – оно
captures several segments (hand and forearm, shoulder and
forearm, etc.). Since on the upper limb, especially in
axillary fossa, well-developed lymphatic pathways, edema
can spread from the fingers to the pectoral muscles.
If a прощупать внутреннюю поверхность плеча или подмышечные
cavities can detect regional lymphadenitis. The lymph nodes
will be increased in size, smooth, painful.
The doctor may determine the presence of erysipelas
primary examination and palpation of the affected area. If a у
the patient has no associated diseases, from additional methods
diagnosis is enough to use only a general blood test. ABOUT
the presence of infection will be indicated by the following indicators:
- Скорость оседания эритроцитов (СABOUTЭ) – более 20 мм/час. ATо время
the height of the disease can accelerate to 30-40 mm / hour. Normalized to
2-3 weeks of treatment (normal – up to 15 mm / hour);
- Лейкоциты (WBC) – более 10,1*109/л. Unfavorable
a sign is considered a decrease in the level of leukocytes less
4*109/л. This indicates the inability of the body
adequately resist infection. Observed with different
иммунодефицитах (ATИЧ, СПИД, рак крови, последствия лучевой терапии)
and with generalized infection (sepsis);
- Erythrocytes (RBC) – a decrease in the level below the norm (less than
3,8*1012/л у женщин и 4,4*1012/л у мужчин)
can be observed in hemorrhagic erysipelas. With других формах, как
the rule remains within the normal range;
- Hemoglobin (HGB) – can also reduce, with hemorrhagic
form of the disease. The rate of the indicator is from 120 g / l to 180 g / l. Reduction
indicator below normal – a reason to start taking iron supplements (with
prescribing them by a doctor). Decrease in hemoglobin level below 75 g / l –
indication for transfusion of whole blood or erythromass.
Instrumental diagnostics is used in case of infringement
blood to limb (ischemia) or the presence of associated diseases,
such as atherosclerosis obliterans, thrombophlebitis, thromboangiitis and
etc. AT этом случае, пациенту могут назначить доплерометрию нижних
limbs, rheovasography or angiography. These methods will determine
patency of vessels and the cause of ischemia.
Any erysipelas if treatment is delayed or started
significantly weakened patient’s body may lead to
the following complications:
- An abscess is a purulent cavity, which is bounded by a capsule of
connective ткани. It is the least dangerous complication;
- Cellulitis – diffuse purulent focus in soft tissues (subcutaneous
tissue or muscle). Causes damage to surrounding structures and
a significant increase in symptoms of intoxication;
- Purulent phlebitis – inflammation of the vein wall on the affected
limbs, which leads to its compaction and contraction. Phlebitis
it is manifested by swelling of surrounding tissue, reddening of the skin over a vein and
increase in local temperature;
- Necrotic erysipelas – skin necrosis in affected streptococcus
- Purulent meningitis – may occur when the erysipelas is located
infections on the face. This is a serious disease that develops.
due to inflammation of the lining of the brain. Manifests itself
cerebral symptoms (unbearable headache, clouding
consciousness, dizziness, etc.) and involuntary tension
certain muscle groups;
- Sepsis is the most dangerous complication of erysipelas, which in 40% of cases
ends with the death of the patient. This is a generalized infection,
affecting organs and leading to the formation of purulent foci
the whole body.
It is possible to prevent the formation of complications, if timely
seek medical help and not be treated
on their own. Only a doctor can determine the optimal tactics.
and prescribe an erysipelas therapy.
Treatment of erysipelas
Uncomplicated forms of erysipelas do not require an operation – their
treated conservatively. Depending on the condition of the patient is solved
the question of the need for his hospitalization. Unambiguous recommendations
there is only in regard to erysipelas on the face – such
Patients should be treated only in the hospital.
The classical scheme of therapy includes:
- Antibiotic – the combination has the best effect.
protected penicillins (Amoxiclav) and sulfonamides (Sulfalen,
Sulfadiazine, Sulfanilamide). As an alternative drug
Ceftriaxone can be used. Recommended time
antibacterial treatment 10-14 days;
- Antihistamine drug – because streptococcus can
compromise the body’s immunity and cause reactions like
allergic, this group of drugs should be used. AT
Currently, the best (but expensive) drugs are
Loratadine and Desloratadine. If the patient is not able to
purchase, the doctor may recommend as an alternative
Suprastin, diphenhydramine, Clemastine, etc .;
- Pain reliever – used for erysipelas
негормональные противовоспалительные средства (НПATСы). Should
give preference to Nimesulide (Nise) or Meloxicam, since
they have the least amount of adverse reactions. Alternative
– Ketorol, Ibuprofen, Diclofenac. Their use should be combined
with taking omeprazole (or rabeprazole, lansoprazole, etc.) that
поможет уменьшить негативное влияние НПATСов на слизистую
- Antiseptic dressings with 0.005% Chlorhexidine – important
component of therapy. When applied, the dressing should be abundant.
wetted with a solution and remain wet for several hours.
A sterile bandage is applied over the dressing.
How to treat erysipelas of the skin, if there are local
complications or a bullous erysipelas developed? AT этом случае, выход
only one – hospitalization in a surgical hospital and execution
As already mentioned, the indications for surgery is
formation of ulcers (phlegmon, abscesses), skin necrosis or
bullous form of erysipelas. Do not be afraid
surgical treatment, in most cases it takes no more
30-40 minutes and is carried out under general anesthesia (anesthesia).
AT ходе операции, хирург вскрывает полость гнойника и убирает его
content. The wound is usually not sutured – it is left open
and install a rubber graduate to drain the fluid. With
detection of dead tissue, they are completely removed, after which
continue conservative therapy.
Surgery буллезной формы рожистой инфекции
happens as follows: the doctor opens the existing bubbles,
treats their surfaces with antiseptic and bandages with
0.005% solution of chlorhexidine. Thus prevented
the addition of another infection.
Skin after erysipelas
AT среднем, лечение рожистой инфекции занимает 2-3 недели. By
as the local inflammatory response decreases and
the amount of streptococcus decreases, the skin begins to renew.
Redness decreases and in place of the damaged area appears
peculiar plenochka – it separates the “old” skin. Once
it will finally be torn away; it should be removed by itself.
Byд ней должен быть неизмененный эпителий.
AT течение следующей недели, может сохраняться шелушение кожи,
what is the normal reaction of the body.
In some patients, erysipelas may take
relapsing course, that is, to appear again in its former place
after a certain time (several years or months). AT этом
case, the skin will be susceptible to trophic disorders,
chronic extremity edema or epithelium replacement
connective tissue (fibrosis).
Frequently asked questions from patients
ATопрос: Насколько опасна эта инфекция?
Erysipelas is a serious disease that is dangerous.
severe intoxication and the development of complications. As a rule, when
timely treatment started, the prognosis is favorable. If a
the patient turned a week later or more from the start of the infection,
his body is weakened by concomitant diseases (diabetes mellitus,
сердечной недостаточностью, ATИЧ и etc.), рожа может привести к
ATопрос: Как восстановить кожу после рожистого
In almost all forms of erysipelas, this process occurs.
on their own, without the intervention of doctors. The main thing is to eliminate
source of infection and local inflammation. An exception
makes up necrotic erysipelas. AT этом случае, кожу можно
restore only surgery (plastic skin).
ATопрос: Byчему рожа возникает несколько раз на
same place? How to prevent this?
AT данном случае, речь идет о рецидивирующей форме рожистого
inflammation. Streptococcus group A has the ability to break
work of immunity, which leads to repeated inflammatory reactions
in the affected skin. Unfortunately, adequate prevention methods
recurrence is not developed.
ATопрос: Byчему в статье не упомянут Тетрациклин
(Unidox, doxycycline) for treating erysipelas?
AT настоящее время, антибиотики Тетрациклинового ряда не
используют для лечения рожистой инфекции. Research
have shown that most hemolytic streptococci are resistant to
this drug is therefore recommended to use the following
antibiotics in the face – a combination of synthetic penicillin +
sulfanilamide or cephalosporin of the 3rd generation (Ceftriaxone).
ATопрос: Should ли использовать физиотерапию при
Not. Physical therapy during the acute period will increase
inflammation and the spread of infection. It should be postponed until
recovery period. Byсле подавления инфекции возможно
use of magnetic therapy or ultraviolet irradiation.
ATопрос: ABOUTтличается ли лечение рожи, при разных
location of the infection (on the face, on the arm, etc.)?
Treatment of erysipelas руки, ноги и любой другой части
body is carried out according to the same principles.