GENERAL

SURGERY
ERYSIPELA
S
-
Sowmya Raja
Group C21-392
 AGENDA
INTRODUCTIO
N
ETIOLOG
Y
RISK FACTORS

SIGNS AND
SYMPTOMS
PATHOPHYSIOLOG
Y
COMPLICATIONS AND
TREATMENT
The skin is made up of three main layers:
1. Epidermis: The outermost layer of the skin, the
epidermis is primarily composed of epithelial
cells. It provides a protective barrier against
external factors such as pathogens, UV radiation,
and chemicals.
2. Dermis: The middle layer of the skin, the
dermis contains blood vessels, nerves,
hair follicles, and sweat glands.
It provides structural support
and elasticity to the skin.
3. Subcutaneous tissue (hypodermis):
innermost layer of the skin, the subcutaneous tissue
is mainly composed of fat cells and connective
tissue. It helps to regulate body temperature and
provides insulation and cushioning for the body.
Erysipelas is a superficial infection that
primarily affects the upper layers of the skin,
including the dermis. It typically appears as a
raised, red, and painful rash.
Impetigo is also a superficial infection, but it
primarily affects the epidermis, which is the
outermost layer of the skin. It is characterized
by small, fluid-filled blisters that burst and
form honey-colored crusts.
Cellulitis, on the other hand, is a deeper
infection that affects the deeper layers of the
skin, including the dermis and subcutaneous
tissue. It often causes redness, swelling,
warmth, and pain in the affected area.
Impetigo is a common and highly contagious bacterial skin infection that mainly affects children, but can also
occur in adults. It is caused by either Staphylococcus aureus or Streptococcus pyogenes bacteria. Impetigo is
characterized by red sores or blisters that can rupture and form a yellowish crust. Pyogenic “pus forming”
infection of epidermis of skin.
Contagious, superficial, purulent infection by streptococcus (Group A Strep) or staphylococcus Infection of the
stratum corneum of epidermis Vesicular lesions that progress to "Honey-crusted lesions", surrounded by
erythematous base Primary vs. Secondary Impetigo (ex. Open skin)
Symptoms of impetigo may
include:
Red sores or blisters that quickly
1.
rupture and form a yellowish
crust.
2. Itching and discomfort in the
affected area.
3. Swollen lymph nodes near the
affected area.
4. Fever in some cases.
Complications of impetigo may
include:1. Cellulitis: A bacterial
skin infection that can spread
beyond the initial impetigo site.2.
Post-streptococcal
glomerulonephritis: A kidney
condition that can develop after a
streptococcal infection.3. Scarring
or pigmentation changes in the
affected skin.
In some cases, if the impetigo is
severe or recurrent, surgery may
be considered as a treatment
option. Surgical procedures
for impetigo may include:
Incision and drainage:
1.
Draining pus or fluid from
large blisters or abscesses.
2. Debridement: Removing
dead or infected tissue to
promote healing.
3. Skin grafting: Transplanting
healthy skin to replace
damaged or infected areas.
Furuncle (Boil):- A furuncle, also known as
a boil, is a bacterial infection of a hair
follicle or oil gland.- It presents as a painful,
red, and swollen lump filled with pus.-
Furuncles can occur anywhere on the body
and may be accompanied by fever or chills.
Carbuncle:- A carbuncle is a cluster of
interconnected furuncles that form a larger,
deeper infection.- It presents as a painful,
swollen, and inflamed mass with multiple
pus-filled nodules.- Carbuncles often occur
on the back of the neck, shoulders, or thighs.
 Erysipelas is a progressive acute
inflammation
Of the skin or rarely of mucous membrane
caused by diverse Streptococcus spp.
-Strep. Pyogenes – the principal human skin
pathogen INTRODUCTION
It has got typical skin rash presenting on legs ,
toes, face and fingers due to acute infection.
It is also responsible for causing sore throat.
It is a skin infection involving the upper (outer
) dermis layer of the skin, but it may also
extend to the superficial cutaneous lymphatics.
It is characterized by an area of erythema that
is well-demarcated, raised, and often affects
the lower extremities, with the face being the INTRODUCTION
second most commonly affected site.
Erysipelas is also referred to as "St. Anthony's
Fire" due to its intense fiery rash.
 Cellulitis Vs Erysipelas
CELLULITIS ERYSIPELAS

Infection with Streptococcus or Staphylococcus

Deep dermis infection Upper dermis infection

Subcutaneous adipose tissue Superficial lymphatics

Indolent onset Acute onset

Localised symptoms Systemic symptoms , non purulent

 ETIOLOGY
The primary inciting infection involves streptococci. Most facial infections are due to Group
A streptococcus while non-group A streptococcus involves more of the lower extremity.
Erysipelas in newborns is often caused by group B streptococci, which may also be
responsible for perineal and lower-trunk erysipelas occurring in postpartum women.
researchers concluded that beta-hemolytic streptococci were the leading cause of facial
cellulitis.
Erysipelas starts with skin breaks and leads to the inoculation of the eliciting bacteria.
Surgical incisions, insect bites, stasis ulcerations, and venous stasis are among the many entry
portals. In addition, facial erysipelas may be caused by a recent infection in the nasopharynx
passage.
Very young/old age RISK FACTORS
• Breaks in skin
• Abrasions, trauma, eczema,
BREAKS
radiation, bites IN SKIN
• Lowered immunity
• Skin infection
• Tinea, impetigo, varicella,
EDEMA LOWERE
rash D
IMMUNIT
• Lymphatic Edema Y
• Lymphatic obstruction,
venous insufficiency SKIN
INFECTIO
N
 SIGNS AND SYMPTOMS
Malaise, elevated fever
• Itchy skin, shivering Hemorrhagic bullae
• Sores on checks and nose Focal necrosis
• Pus filled lumps Hypoesthesia
• Vomiting
Livedo reticularis
• Headache
Major edema
• Fatigue
• Enlarged lymphatic nodes Redness
swelling, pain
 The condition is characterised by acute onset (rigors, severe headache,
tachycardia, tachypnoea, fever as high as
40-41°C and typical signs of intoxication, i.e. insomnia, oliguria,
proteinuria, haematuria, leukocyturia and hyaline and
granular casts present in the urine).
Marked hyperaemia (flame-like) is the major local sign of erythaematous
erysipelas, which is usually accompanied by burning sensation and fever.
The signs of bullous erysipelas are all those of erythaematous
erysipelasaccompanied by serous, purulent or haemorrhagic
blisters of various size.
 In phlegmonous erysipelas, the local signs, i.e. hyperaemia, pain, itching, are moderate,
while general ones (rigors, fever, tachycardia) may be pronounced.
Necrotic erysipelas presents as black solid painless lesions of the skin at the sites of former
hyperaemia, blisters or oedema.
CLINICAL FEATURES
Erysipelas predominantly affects the skin of the lower limbs, but when it
involves the face, it can have a characteristic butterfly distribution on the
cheeks and across the bridge of the nose.
The affected skin has a very sharp, raised border.It is bright red, firm and
swollen.
It may be finely dimpled (like an orange skin).It may be blistered, and in severe
cases may become necrotic.
Bleeding into the skin may cause purpura.
Cellulitis does not usually exhibit such marked swelling but shares other
features with erysipelas,
such as pain and increased warmth of affected skin.In infants, it often occurs
in the umbilicus
or diaper/napkin region.Bullous erysipelas can be due to streptococcal
infection or
co-infection with Staphylococcus aureus (including MRSA).
 PATHOPHYSIOLOGY
The pathophysiology of erysipelas involves several key steps:
1. Entry of Bacteria: The bacteria responsible for erysipelas typically enter the body through breaks in the skin, such as cuts,
abrasions, or insect bites. These bacteria can also colonize on the skin and enter through areas of compromised skin integrity.
2. Infection and Inflammation: Once inside the body, the bacteria multiply rapidly and release toxins that trigger an
inflammatory response. This leads to the characteristic signs of erysipelas, including redness, warmth, swelling, and pain in
the affected area.
3. Lymphatic Spread: Erysipelas primarily affects the upper dermis and superficial lymphatics of the skin. The infection can
spread rapidly through the lymphatic vessels, leading to the classic sharply demarcated, raised borders seen in erysipelas
lesions.
4. Immune Response: The body's immune system responds to the bacterial invasion by recruiting white blood cells to the site
of infection to combat the bacteria. This immune response contributes to the inflammation and swelling observed in erysipelas.
5. Toxin Production: Some strains of group A Streptococcus produce toxins that can damage tissue and blood vessels, leading
to further inflammation and tissue injury in the affected area.
6. Systemic Effects: In severe cases, erysipelas can lead to systemic symptoms such as fever, chills, malaise, and
lymphadenopathy as the body mounts a more widespread immune response to the infection.
7. Complications: If left untreated or if the infection spreads, erysipelas can lead to complications such as abscess formation,
cellulitis (deeper skin infection), sepsis (bloodstream infection), or necrotizing fasciitis (a severe soft tissue infection).
Treatment of erysipelas typically involves antibiotics to target the causative bacteria, along with supportive measures such as
rest, elevation of the affected limb (if applicable), and pain management.
 PATHOANATOMY
The pathoanatomy of erysipelas involves specific changes in the affected skin and underlying tissues, including:

1. Localized Inflammation: a well-demarcated, erythematous (red) patch of skin with raised borders. The affected area is typically warm,
tender, and swollen due to the inflammatory response triggered by the bacterial infection.

2. Lymphatic Involvement: The bacteria responsible for erysipelas, such as group A Streptococcus or Staphylococcus aureus, can quickly
spread through the superficial lymphatic vessels in the skin. This leads to the characteristic spreading, sharply demarcated borders seen
in erysipelas lesions.

3. Edema and Cellulitis: The inflammatory process in erysipelas causes increased permeability of blood vessels, leading to leakage of
fluid into the surrounding tissues. This results in edema (swelling) and can progress to cellulitis, a deeper skin infection involving the
dermis and subcutaneous tissue.

4. Vascular Changes: The toxins produced by certain strains of bacteria in erysipelas can damage blood vessels, leading to vasodilation
(widening of blood vessels) and increased blood flow to the affected area. This contributes to the redness and warmth observed in
erysipelas lesions.

5. Neutrophil Infiltration: Neutrophils, a type of white blood cell involved in the body's immune response, are recruited to the site of
infection in erysipelas. These cells help combat the bacteria but also contribute to tissue damage and inflammation in the affected area.

6. Skin Barrier Disruption: The entry of bacteria through breaks in the skin disrupts the normal skin barrier function, allowing the
pathogens to invade and multiply in the underlying tissues. This compromised barrier function contributes to the rapid spread of infection
in erysipelas.

7. Systemic Effects: In severe cases of erysipelas, the systemic effects of the infection can involve activation of the immune system,
leading to symptoms such as fever, chills, and malaise. Lymphadenopathy (enlarged lymph nodes) may also occur as the body responds to
the infection.
COMPLICATIONS
 COMPLICATIONS
The most common
complications of erysipelas include
Abscess,
Gangrene, and
Thrombophlebitis
Chronic leg swelling
Septic Shock
Cellulitis
Lymphangitis
Systemic infection
Infections distant to the site of erysipelas• Infective endocarditis
(heart valves)
• Septic arthritis
• Bursitis
• Tendonitis
• Post-streptococcal glomerulonephritis (a kidney condition
affecting children)
• Cavernous sinus thrombosis (dangerous blood clots that can
spread to the brain)
• Streptococcal toxic shock syndrome (rare).
DIAGNOSIS by examining visible symptoms such as
sores, blisters, or raised skin rashes.
The blood test may show:
High levels of white blood cells
(indicating tissue damage or bacterial
infection)
High levels of C-reactive protein
(indicating inflammation)
+ve culture –presence of bacteria
MRI and CT scan –deep infection.
DIAGNOSIS Its diagnosis can overlap with
cellulitis, and often a definite
diagnosis cannot be made. Cellulitis
has ill-defined borders and is slower
to develop, while erysipelas has
better-defined borders and faster
development. Erysipelas can be
serious but rarely fatal. It has a rapid
and favorable response to antibiotics.
The most common cause is group A
streptococci.
 TREATMENT
Antibacterial therapy with penicillins coupled with ultraviolet is applied as long
as hyperaemia begins to subside and body temperature becomes normal.
It should be noted that wet bandages, compresses or baths are absolutely contra-
indicated.
After cleansing with ethanol, blisters should be opened and covered by dressing
with synthomycin emulsion, streptoccid suspension or tetracycline ointment.
Phlegmonous and necrotic erysipelas both require opening of purulent blisters,
their drainage and removal of necrosis.
Autodermoplasty is used to close granulating wounds.
Oral or parenteral antibiotics
First-line oral antibiotics for erysipelas include one the following

Penicillin V 500 mg every 6 hours

Amoxicillin 875 mg every 12 hours
Cephalexin 500 mg every 6 hours
Cefadroxil 500 mg every 12 hours or 1 g once a day
The 1st-line parenteral antibiotic (for severe cases) is parenteral aqueous
crystalline penicillin G 4 million units IV every 4 hours.
Alternative parenteral antibiotics are ceftriaxone 1 to 2 g IV once a day
and cefazolin 1 to 2 g IV every 8 hours.
Oral therapy: penicillin
Intravenous penicillin
Vancomycin for facial erysipelas caused by MRSA
Alternative to penicillin: erythromycin (for people allergic to penicillin)
Antiallergic drugs, mineral complexes, and vitamins are sometimes
added to the antibiotics to increase their effectiveness.

General treatment of erysipelas includes:

Applying cold packs to relieve discomfort
Elevating your legs to reduce swelling
Dressing the wound
 Surgery
The surgical procedure for erysipelas typically involves incision and drainage of any
abscesses or infected areas. Here is a step-by-step guide to the surgical procedure
for erysipelas:
1. Preparation: The patient is positioned comfortably, and the area affected by
erysipelas is cleaned and sterilized with an antiseptic solution.
2. Anesthesia: Local anesthesia is administered to numb the area around the
affected skin to minimize pain during the procedure.
3. Assessment: The healthcare provider examines the affected area to determine
the extent of infection, identify any abscesses that may need drainage, and assess
the overall condition of the skin.
4. Incision and drainage: If there are any abscesses present, the healthcare provider
makes small incisions in the skin to allow for drainage of pus and infected material.
The abscess cavity is then gently squeezed to remove as much pus as possible.
5. Debridement: Any dead or necrotic tissue in the affected area may be removed
through debridement to promote healing and prevent further spread of infection.
 Surgery
6. Irrigation: The incision sites and any open wounds are irrigated with
a sterile saline solution to flush out any remaining pus, debris, or
bacteria. This helps clean the area and reduce the risk of reinfection.
7. Dressing: The incision sites and any open wounds are covered with
sterile dressings to protect them from contamination and promote
healing. The dressings may be secured with adhesive tape or
bandages.
8. Postoperative care: The patient is given instructions on how to care
for the incision sites and wounds, including keeping them clean,
changing dressings regularly, taking any prescribed antibiotics or pain
medications, and monitoring for signs of infection.
Surgical procedure for carbuncle
Infiltration of Local Anesthesia
Making skin incision
Drainage of abscess from the cavity
Irrigation of abscess cavity with saline solution
Wound packing is done with providine gauze
 INSTRUMENTS USED FOR
SURGERY
Some common instruments used for abscess
drainage and incision include:
1. Scalpel: A sharp surgical knife used to make the
initial incision in the skin overlying the abscess.
2. Forceps: Surgical instruments used to hold tissues
or manipulate objects during the procedure.
3. Scissors: Used to cut and dissect tissues, such as
cutting through layers of skin or tissue to access the
abscess.
4. Hemostats: Clamping tools used to control bleeding 7. Gauze and sponges: Used to clean and pack
during the procedure by clamping off blood vessels. the abscess cavity after drainage.
8. Dressing materials: Including sterile gauze,
5. Syringe and needle: Used to aspirate or extract pus adhesive bandages, and tape to cover and
and fluid from the abscess cavity. protect the incision site after the procedure.
6.irrigation syringe: Used to flush the abscess cavity
with saline solution to clean out any remaining pus or
debris.
 Surgical procedure for abscess
1. Preparation: The patient is prepared for the surgical procedure by
cleaning the skin around the abscess with an antiseptic solution.

2. Anesthesia: Local or general anesthesia is administered to numb the

area around the abscess and ensure the patient does not feel any pain
during the procedure.

3. Incision: The surgeon makes a small incision in the skin overlying the
abscess to allow drainage of pus and fluid. This helps to relieve pressure
and pain.

4. Drainage: The surgeon uses a scalpel or other instrument to carefully

drain the pus and fluid from the abscess. The area may be gently
squeezed to help remove all the infected material.

5. Cleaning: The inside of the abscess cavity is cleaned thoroughly with

 Surgical procedure for abscess
6. Packing: In some cases, the surgeon may insert a small piece of
gauze or a drain into the abscess cavity to help it continue to drain
and prevent re-accumulation of pus.
7. Closure: Once the abscess has been drained and cleaned, the
incision is closed with sutures or left open to heal on its own,
depending on the size and location of the abscess.

8. Post-operative care: The patient is given instructions on how

to care for the surgical site, including changing dressings,
taking antibiotics if prescribed, and watching for signs of
infection.
 PREVENTION
1. If you have conditions like diabetes or lymphedema, work with your
healthcare provider to manage them effectively to reduce the risk of
developing erysipelas.
2. If you have any cuts, scrapes, or other skin injuries, clean them
thoroughly and apply an antiseptic ointment to prevent infection.
3. Use appropriate protective measures, such as wearing gloves
and long sleeves when working in environments that may expose your skin
to potential infections.
THANK YOU …