Erysipelas (English spelling)

Japanese: 丹毒 - たんどく（英語表記）Erysipelas

What is the disease?

A shallow area of the skin caused by a streptococcal infection ( Dermis ( Mystery ) It is a purulent inflammation of the skin. It can also be called cellulitis that occurs in the shallow part of the skin. It often occurs in elderly people and those with weakened immune systems.

What is the cause?

Suppuration chain ( Rensa ) It is often caused by cocci. The bacteria enter the dermis from the surface of the skin and cause an inflammatory reaction, but it can also occur when bacteria reach the dermis from other parts of the body via the blood. edema ( Fushu ) ) are also important incentives.

How symptoms manifest

Sudden high fever, Chills ( Mom ) , whole body Fatigue ( Health test ) Accompanied by the above symptoms, a bright red swelling with a clear border appears on the skin, which spreads rapidly to the surrounding area (Figure 51). The surface of the skin is taut, hard and shiny, and the affected area feels hot and is very painful to touch. Blisters ( Water ) It may also be accompanied by bleeding spots.

It is most common on the face (especially the cheeks, ears and around the eyes), lower and upper limbs, hands and feet, and nearby lymph nodes are usually swollen and painful.

With proper treatment, the skin on the surface will peel off and the condition will heal in about a week. However, if the correct treatment is not given, Sepsis ( Dismissal ) , Meningitis ( Zuimakuen ) In some cases, the disease may become serious due to complications such as nephritis. When the disease recurs habitually in the same area, it is called habitual erysipelas, which has been increasing recently and is caused by chronic lymphatic congestion.

Testing and diagnosis

Blood tests show an increase in white blood cells, an increase in CRP (an inflammation test item), and an increase in erythrocyte sedimentation rate. Antibodies to streptococci (ASO, ASK) may increase. Although it is not always clear to distinguish it from cellulitis, cellulitis is a purulent inflammation in the subcutaneous fat tissue deeper than erysipelas, and is mainly caused by Staphylococcus aureus. Necrotizing fasciitis ( Escherichia coli ) In this case, the lesion extends from the subcutaneous fat tissue to the fascia below, spreading rapidly and causing very serious symptoms such as shock.

It also needs to be distinguished from contact dermatitis (rash) and insect bites, but the differences can be seen in the symptoms.

Treatment methods

Since the cause is mainly Streptococcus pyogenes, the first choice is to take a penicillin antibiotic orally or by injection. To prevent recurrence and the risk of nephritis, take antibiotics orally for about 10 days after recovery. The affected area should be kept at rest and a cold compress applied.

Tada Yoshiharu

Fig. 51 Erysipelas (left cheek)
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Fig. 51 Erysipelas (left cheek)

Source: Houken “Sixth Edition Family Medicine Encyclopedia” Information about the Sixth Edition Family Medicine Encyclopedia

Japanese:

どんな病気か

　連鎖球菌の感染によって起こる皮膚の浅いところ（真皮(しんぴ)）の化膿性炎症です。皮膚の浅いところに生じた蜂窩織炎(ほうかしきえん)ともいえます。高齢者や免疫力の低下した人に多く発症します。

原因は何か

　化膿連鎖(れんさ)球菌によってよく起こります。菌は皮膚の表面から真皮内に入り炎症反応を生じますが、他の部位から血液を介して菌が真皮に達し生じることもあります。手術のあとや局所のはれ（浮腫(ふしゅ)）なども誘因として重要です。

症状の現れ方

　突然、高い熱、悪寒(おかん)、全身の倦怠感(けんたいかん)を伴って、皮膚に境のはっきりしたあざやかな赤い色のはれが現れ、急速に周囲に広がります（図51）。表面は皮膚が張って硬く光沢があり、その部分は熱感があって触れると強い痛みがあります。水疱(すいほう)や出血斑を伴うこともあります。

　顔（とくに頬・耳・眼のまわり）、下肢、上肢、手足に多くみられ、近くのリンパ節がはれて痛みがあるのが普通です。

　適切な治療により、1週間前後で表面の皮がはがれてきて治りますが、正しい治療が行われないと、敗血症(はいけつしょう)、髄膜炎(ずいまくえん)、腎炎などを合併して重篤になることがあります。同じ部位に習慣性に再発を繰り返す場合を習慣性丹毒と呼び、最近増えていますが、慢性のリンパうっ滞が誘因となります。

検査と診断

　血液検査では、白血球が増え、CRP（炎症検査の項目）の上昇、赤沈の亢進がみられます。連鎖球菌に対する抗体（ASO、ASK）が上昇することがあります。蜂窩織炎との区別は必ずしもはっきりしませんが、蜂窩織炎は丹毒より深い部分の皮下脂肪組織での化膿性炎症で、主に黄色ブドウ球菌によって起こります。壊死性筋膜炎(えしせいきんまくえん)では、皮下脂肪組織から下の筋膜が病変の場となり、急速に広がって、ショックなど非常に重篤な病状になります。

　そのほか、接触皮膚炎（かぶれ）や虫刺されなどとも区別が必要ですが、それぞれの症状から区別できます。