This is most commonly seen in the skin as widespread erythema and cellulitis. The organisms gain entry through fissures in the skin, e.g. in a toe-cleft, and the skin becomes red, swollen and tender. Constitutional symptoms of fever, malaise and hallucinations often accompany the cutaneous features. With recurrent disease the area affected, e.g. the foot and lower leg, may become lymph oedematous.
Acute cases should be treated with penicillin 1 g per day. Any underlying skin disease should be treated with local antiseptics applied as paints or dusting powder on areas of chronic fissuring. Foot soaks that are bacteriostatic and astringent, e.g. potassium permanganate 0.01% solution, might be prescribed when maceration of the toe-clefts is associated with excessive sweating. Recurrent erysipelas may require long-term prophylaxis with oral penicillin or erythromycin.
This disease is uncommon in the UK except in drug addicts or patients with HIV infection. Chronic ulceration is produced by infection of the dermis and both Strep. pyogenes and Staph. aureus may be isolated from the same wound.
Debilitation, poor hygiene or nutrition are important contributing factors. Often prolonged and intensive local antiseptic treatment combined with systemic antibiotics will be needed to heal the skin.
Erysipeloid is an acute infective disease of the skin. It is most often localized to areas that have been traumatized by contact with carcasses and bones of pigs, chickens or fish. The condition is therefore seen in butchers, meat porters, fishermen or, rarely, those working in the home. The causative organism is Erysipelothrix insidiosa, which also causes swine erysipelas, a serious and systemic disease
of pigs. In humans, well-demarcated blue/red discoloration is noticed on the hands, fingers or arms. This follows several days after laceration or abrasion and clears without sequelae. Rarely, fever and malaise accompany the common cutaneous presentation and cases of systemic and cutaneous disease resembling swine erysipelas have been recorded.
The disease is self-limiting and lasts about 7-10 days. If treatment is required, then penicillin given for a week is effective.