The term erysipelas (erythros = red, pella = skin) was used in Hippocratic times (often but not always) to describe classic cellulitis. For the past century or so, however, erysipelas has commonly referred to infection of the derma with a streptococcal organism, usually Streptococcus pyogenes. Infection with a group A, beta-hemolytic streptococcus can produce a painful, red, edematous indurated skin lesion called peau d’orange for its resemblance to the texture of an orange skin. Sharp borders of the infection extend rapidly, dissecting the underlying dermis from the epidermis. Erysipelas usually appears on the face, producing a butterfly rash over the cheeks and nose. The same streptococci that cause erysipelas can also cause scarlet fever, giving both diseases a fairly distinctive age pattern: Erysipelas is much more common among adults who generally escape scarlet fever, which normally attacks the young. The prognosis for untreated erysipelas is especially serious when this infection is secondary to some other insult such as laryngeal infection, or puerperal sepsis. Indeed distinctions are still made among gangrenous erysipelas, erysipelas grave internum (a form of puerperal fever), surgical erysipelas (which occurs after a surgical procedure), and traumatic erysipelas (which begins in a wound).

History

Antiquity Through the Eighteenth Century

Early accounts of erysipelas are often confusing because they lumped purulent and gangrenous afflictions under this rubric. Thus Hippocrates distinguished between “traumatic” erysipelas, which accompanied wounds, and a myriad of other skin lesions that had no known external cause. Galen in turn distinguished between “phlegmon,” including suppurative ulcers and gangrene, and nonnecrotic cellulitis – but viewed both as forms of erysipelas.