Recurrent erysipelas A46

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Chronic erysipelas; Erysipelas recidivans; recurrent celulitis; recurrent erysipelas; Recurrent erysipelas

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Erysipelas recurring at irregular intervals.

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Congenital or acquired lymphatic drainage disorders. Partial immunodeficiency of the organism against streptococcal antigen.

The following anamnestic and clinical data are associated with an increased risk of recurrence:

  • Chronic lymphedema (main predictor)
  • Location: Lower leg
  • Previous tumor disease with consecutive lymphatic drainage disorder (e.g. breast carcinoma with lyphadenectomy).
  • Previous saphenectomy due to coronary bypass surgery
  • Chronic eczema (e.g. stasis dermatitis)
  • Chronic venous insufficiency.

Clinical features
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First recurrences occur with analogous clinical symptoms as the primary manifestation. With increasing recurrence frequency, the acute nature of the infection disappears. Only a discrete redness and overheating, possibly complete absence of fever and leucocytosis is observed. In most cases, an initially discreet lymphedema persists, which becomes more pronounced with increasing recurrence frequency.

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Persistent lymphedema, consecutive sclerosis, pigmentary shifts, pachydermia, elephantiasis inflammatoria.

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  • In the acute stage antibiotics. S.u. Erysipelas.
  • In case of underlying or secondary lymph drainage disorders, compression therapy with elastic short-stretch bandages as well as manual and, if necessary, additional intermittent lymphatic drainage by apparatus (30 min./day).


    Lymphatic drainage in case of inflammation due to danger of sepsis only under antibiotic protection!
    • Satisfactory long-term therapy successes are achieved by intermittent penicillin therapy (several studies with evidence level up to IIa). Therapy schedule 1: Penicillin G every 3 months (10 million IU/day penicillin i.v. over 10 days); treatment period: 1 year.
    • Therapy schedule 2: Penicillin V 250mg 2x/day p.o. for a period of 6 months. In this study (123 patients) the risk of recurrence was reduced by about 50%.
    • In case of penicillin intolerance use Erythromycin 2 times/day 1 g i.v. for 10 days or Cephalosporins ( Ceftriaxon 2g i.v./day).

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  1. Chlebicki MPet al. (2014) Recurrent cellulitis: risk factors, etiology,pathogenesis and treatment. Curr Infect Dis Rep 16:422
  2. Inghammar M et al (2014) Recurrent erysipelas--risk factors andclinical
    presentation. BMC Infect Dis 14: 270

  3. McNamara DR et al (2007) A predictive model of recurrent lower extremity cellulitis in a population-based cohort. Arch Internal Med 167: 709-715
  4. Thomas K et al(2012) Prophylactic antibiotics for the prevention of cellulitis (erysipelas) of the leg: results of the UK Dermatology Clinical Trials Network's PATCH II trial. Br J Dermatol 166:169-178.


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Last updated on: 29.10.2020