Blistering erysipelas: not a rare entity

Soft tissue infections are common, but erysipelas, especially its blistering feature, is an under-recognised entity. There have been few reports of blistering erysipelas. We aim to describe the clinical characteristics, management and the risk factors for erysipelas in 20 patients admitted in a tertiary hospital in Singapore.

A chart review of all cases of erysipelas, diagnosed by experienced dermatologists and admitted to the Singapore General Hospital during the period January 2006 to August 2006, was conducted.

There were 20 patients (11 male, nine female) with an average age of 62.2 (range 31-86) years. The most commonly-involved site was the leg (75 percent), followed by the arm (15 percent) and face (ten percent). The clinical characteristics were well dermarcated (50 percent), erythema (100 percent) and oedema (85 percent), and bullae and vesicles formation (80 percent). Most presented with no pain (40 percent) and minimal signs of systemic toxicity. There was no positive blood culture, but the swab on the blistering erysipelas yielded positive cultures in 67 percent. The most common predisposing factor was disruption in the skin barrier (65 percent), followed by venous insufficiency (20 percent) and lymphoedema (25 percent). All patients received empirical antibiotics, most commonly penicillin and cloxacillin (65 percent), for an average duration of 20.65 (10-41) days, and with local care, there was complete resolution.

In our experience, erysipelas is a clinically distinct entity and commonly presents with bullae or vesicles. It has favourable prognosis, and rarely develops any complication with timely and appropriate therapy.