HomeHealth articleserysipelasWhat Is Erysipelas and How to Treat It?

Erysipelas - Causes, Symptoms, and Treatment

Verified dataVerified data

4 min read


Erysipelas is a bacterial infection of the upper dermis, extending to the superficial lymphatic vessels within the skin. Read below to know more.

Written by

Dr. Karthika Rp

Medically reviewed by

Dr. Shubadeep Debabrata Sinha

Published At November 25, 2022
Reviewed AtSeptember 11, 2023


Erysipelas is a superficial form of cellulitis, a common bacterial skin infection of the lower dermis and subcutaneous tissue. It is typically characterized by a localized area of erythema or redness, pain, swollen skin, and other systemic symptoms. If left untreated, cellulitis can be life-threatening. In addition, a potentially severe bacterial infection affects the skin. Erysipelas affects the upper dermis, and the features of erysipelas will extend into the superficial cutaneous lymphatics. Erysipelas is also known as Saint Anthony's fire due to its intense rash.

What Is Erysipelas?

Erysipelas is an infection affecting the skin's upper layers (superficial). The most common etiology of erysipelas is group A Streptococcal bacteria, most importantly Streptococcus pyogenes. Erysipelas usually present with a fiery erythematous rash, and the edges of the rash are raised that can easily be differentiated from the skin around it.

In addition, the affected skin may be warmer. It is believed that erysipelas will mainly affect the areas on the face. Still, recent studies suggest that the distribution of inflammation in erysipelas will also be observed in the legs in most cases. Therefore, the erythematous rash may also be present on the arms and trunk. Erysipelas also commences with minor skin trauma, including a bruise, wound, burn, and the incision at the site of a surgical incision or a wound. The rash occurs on the trunk, arms, and legs.

What Are the Causes of Erysipelas?

The etiology of erysipelas is caused by group A beta-hemolytic Streptococci such as Streptococcus pyogenes, Staphylococcus aureus, and methicillin-resistant strains (MRSA), Streptococcus pneumoniae, Klebsiella pneumoniae, and Yersinia enterocolitica. Haemophilus influenza has also been found rarely to cause erysipelas. Erysipelas usually affects infants and older people. Erysipelas has no gender or age preferences. However, erysipelas has some risk factors similar to cellulitis variants.

Some of the risk factors of erysipelas are mentioned below:

  • People with a previous history of erysipelas.

  • Trauma or injury in the skin barrier due to insect bites and ulcers.

  • Chronic skin conditions like psoriasis, athlete's foot, and eczema.

  • Other forms of skin injury like trauma, surgical wounds, and radiotherapy.

  • Umbilical cord exposure in newborn babies.

  • Vaccination site injury.

  • Nasopharyngeal infection.

  • Some venous diseases include gravitational eczema, leg ulceration, and lymphoedema.

  • Immune deficiency conditions such as human immunodeficiency virus (HIV).

  • Diabetes.

  • Excessive alcohol intake.

  • Excessive body weight and obesity.

  • Nephrotic syndrome.

  • Pregnancy.

What Are the Symptoms of Erysipelas?

The symptoms and signs of erysipelas are present with fevers, chills, and shivering. The clinical features of erysipelas mainly affect the skin of the lower extremities, and a key butterfly distribution feature is seen on the cheeks and across the nasal bridge.

Some other symptoms of erysipelas are given below:

  • The affected skin in people with erysipelas will have a sharp and raised border.

  • The localized lesion is tender and red.

  • Skin appears bright red, firm, and swollen.

  • Sometimes, the skin may be finely dimpled and resemble orange skin.

  • In severe cases, necrosis and blisters are present.

  • Skin bleeding may cause purpura.

  • Cellulitis symptoms, including pain and increased warmth of affected skin, are present.

  • In infants, the erysipelas symptoms are present in the umbilicus and diaper or napkin areas.

  • Bullous erysipelas may arise due to streptococcal infection or co-infection with Staphylococcus aureus, methicillin-resistant strains, and MRSA.

  • Malaise.

How to Diagnose Erysipelas?

Erysipelas is diagnosed with a history of symptoms and physical examinations.

There are various diagnostic methods, and some of the diagnoses of erysipelas are mentioned below:

  • Blood examinations increased white blood cell count.

  • Increased C reactive protein.

  • Blood culture.

  • Imaging techniques include magnetic resonance imaging (MRI) and computed tomography (CT).

  • Skin biopsy.

What Is the Treatment of Erysipelas?

The treatment is based on the management of symptoms and medical therapy. The symptoms are managed with some general measures. Antibiotics are used for 10 to 14 days.

The various treatment modes for treating erysipelas are mentioned below.

  • Cold compress to relieve discomfort.

  • Limb elevation can reduce swelling.

  • Saline dressings are done to improve wound care.

Medical therapy for erysipelas is mentioned below:

  • Administration of antibiotics such as Penicillin, Clindamycin, or Erythromycin by oral route.

  • Intravenous Penicillin.

  • Vancomycin for facial erysipelas.

  • Erythromycin is an alternative medication option for individuals who are allergic to Penicillin.

  • Antiallergic drugs, mineral complexes, and vitamins are the additional supportive medications prescribed along with antibiotics to increase their effectiveness.

What Is the Differential Diagnosis of Erysipelas?

The signs and symptoms of erysipelas are similar to other skin conditions. Therefore, comparing symptoms will be helpful in differential diagnosis and avoiding misdiagnosis.

Some of the differential diagnoses of erysipelas are mentioned below:

  • Orbital Cellulitis - Orbital cellulitis is a bacterial skin infection. It is characterized by tissue inflammation surrounding the eye. Pain in the eye socket, abnormal eyeball protrusion, impaired eye movement, eyelid swelling, and fever are the symptoms.

  • Herpes Zoster - Herpes zoster is a central nervous system viral infection. Blisters, neural pain, and severe skin itching are present. The affected skin is typically susceptible and painful.

  • Contact Dermatitis - Systemic contact dermatitis is a common skin inflammatory condition due to systemic exposure to allergens. Systemic contact dermatitis can be caused due to allergens, including metals, drugs, and sometimes even foods. The other name for systemic contact dermatitis is allergic contact dermatitis syndrome and baboon syndrome; Baboon syndrome is also called symmetrical drug-related intertriginous and flexural exanthema or SDRIFE, the variant of systemic contact dermatitis.

  • Dermatolymphangioadenitis - Dermatolymphangioadenitis (DLA) is an erythematous skin disorder. Symptoms may include malaise, fever, and chills. DLA is most often followed after surgery, trauma, and lymphedema dermatitis. The periodic low doses of Benzathine penicillin will prevent the recurrence of DLA.

What Are the Severe Complications of Erysipelas?

In case of severe infections, erysipelas has complications. Persistent risk factors and any lymphatic damage can cause severe outcomes.

Some of the difficulties of erysipelas are mentioned below:

  • Chronic abscess.

  • Thrombophlebitis.

  • Chronic leg swelling.

  • Gangrene.

  • Infective endocarditis.

  • Septic arthritis.

  • Bursitis.

  • Tendonitis.

  • A kidney condition affecting children, like post-streptococcal glomerulonephritis

  • Cavernous sinus thrombosis is a dangerous blood clot that can spread to the brain.

  • Streptococcal toxic shock syndrome may rarely occur.

How to Prevent Erysipelas?

Preventive measures are taken to avoid or reduce the risk of erysipelas.

  • Properly cleaning and covering wounds is essential for individuals with open injuries.

  • Effectively treat underlying skin conditions such as athlete's foot or eczema to prevent the recurrence of erysipelas.

  • Diabetes patients should be extra cautious in maintaining good foot hygiene.

  • It is always advisable to seek medical supervision in case the symptoms arise.

  • People with a history of recurrence of erysipelas should complete prolonged antibiotic treatment to prevent further reinfection.


Erysipelas is a skin infection caused by group A Streptococcal bacteria, most importantly Streptococcus pyogenes. Symptoms of erysipelas include bright red skin in association with fever. The most commonly affected areas are the face and lower extremities. The symptoms of erysipelas are similar to cellulitis. The diagnosis is made with a blood evaluation. The treatment of erysipelas includes antibiotics administration. However, erysipelas is not a life-threatening condition and responds well to treatment.

Frequently Asked Questions


What Are Erysipelas Commonly Known As?

Erysipelas is also known as St. Anthony's Fire because of the intense, fiery rash it causes. It is difficult to make a definitive diagnosis for erysipelas because its diagnosis can overlap with that of cellulitis. However, erysipelas has better-defined borders and develops more quickly than cellulitis, which has ill-defined borders and takes longer to develop.


Can Erysipelas Be Cured?

Erysipelas can be treated. When erysipelas is treated, symptoms like fever and illness typically go away within a few days, but the skin infection can last for weeks. Scarring is usually not present. All infected sites receive the same treatment for erysipelas. Antibiotics are usually prescribed for the infection. However, in severe cases, additional care may be required. For instance, elevating one's legs is a good idea when suffering from leg pain.


What Is the Recovery Time of Erysipelas?

Erysipelas can be treated with medication and other methods, and the swelling and pain typically subside in 10 to 14 days. Antibiotic treatment is usually prescribed for five days. However, if the infection does not improve, it can be extended to 10 days.


Does a Virus Cause Erysipelas?

A virus does not cause erysipelas. Instead, it is a form of cellulitis and a common bacterial infection affecting the skin. It is caused by a strain of bacteria called Streptococcus pyogenes, whereas the Staphylococcus strain of bacteria causes cellulitis.


How Does Erysipelas Develop?

Erysipelas is an infection of the skin and usually develops when the causative bacteria enter the skin through skin breaks in the form of cuts or sores. This entry through the skin then leads to the inoculation of the bacteria. The following skin injuries can increase the risk of developing erysipelas -
- Ulcers. 
- Cuts to the skin. 
- Bed sores. 
- Bites from bugs or animals.


Is Erysipelas Similar to Shingles?

A superficial bacterial infection of the skin known as erysipelas is typically brought on by Group A Streptococci. Typically, it appears as a unilateral fiery red or purple rash on the face. Shingles is a viral infection brought on by the Varicella-Zoster virus getting reactivated.


Can Erysipelas Recur?

Erysipelas is a bacterial skin infection that is infectious and frequently occurs in older people. It has a tendency to recur. The potential risk factors for the recurrence of erysipelas include -
- Obesity.
- Surgery.
- Diabetes mellitus (high blood sugar).
- Venous insufficiency (leg veins do not allow blood to flow back to the heart).
- Lymphedema (swelling in an arm or leg due to lymphatic system blockage).


Which Are the Most Common Bacterial Infections?

Some common bacterial infections include the following -
- Urinary tract infections (UTIs).
- Food poisoning.
- Some ear, skin, or sinus infections.
- Bacterial pneumonia.
- Sexually transmitted infections.


Which Is the Most Serious Bacterial Infection?

Mycobacterium tuberculosis is the most lethal bacterial infection that humans contract. It is the leading infectious disease in the world, resulting in more than 1,700,000 deaths annually. In addition, about 6 percent of cases are resistant to or unresponsive to virtually all treatments, and up to 13 percent are resistant to most antibiotics.


Which Is the Most Serious Skin Infection?

One of the most serious skin infections is necrotizing fasciitis. Necrotizing fasciitis is a severe infection that causes tissue death, or necrosis, in the skin, the tissue below the skin, and the fascia. This fibrous tissue that separates muscles and organs. If the infection is not treated quickly, it spreads quickly and can be fatal.


What Is the Site of Origin of the Superficial Lymphatic Vessels?

Superficial lymphatic vessels are thin-walled channels lined by endothelial cells. The site of origin of the lymphatic vessels is the capillary beds. The blood and inflammatory cells are returned to the interstitial tissue via these vessels, which are a drainage system.


What Is the Role Played by the Lymphatic Vessels?

As lymph moves toward larger vessels known as collecting ducts, lymphatic vessels collect and filter it (at the nodes). These vessels function similarly to veins. However, they operate at very low pressure and are equipped with several valves to ensure the fluid moves in only one direction.


What Is the Location of Superficial Blood Vessels?

A superficial vein is often visible because it is close to the body's surface. For example, superficial veins may appear during intense strength training or lifting heavy weights. This is because the blood travels from the tissues beneath the skin to the deep veins through the superficial vessels.


Where Does the Drainage of Lymphatic Vessels Occur in the Body?

The lymph is discharged from lymphatic vessels into the right and left lymphatic ducts, the thoracic duct. Lymph is returned to the bloodstream via these ducts, which connect to the subclavian vein. Below the collarbone is where the subclavian vein runs.


What Is the Number of Lymphatic Vessels in the Body?

About 500 to 600 lymph nodes are scattered throughout the body. Some of these lymph nodes exist as a single node, while others may be closely connected in groups called chains. Inside nodes, specialized blood vessels allow fluid, proteins, and cells to move in either direction.
Source Article IclonSourcesSource Article Arrow
Dr. Shubadeep Debabrata Sinha
Dr. Shubadeep Debabrata Sinha

Infectious Diseases


Community Banner Mobile
By subscribing, I agree to iCliniq's Terms & Privacy Policy.

Source Article ArrowMost popular articles

Do you have a question on


Ask a doctor online

*guaranteed answer within 4 hours

Disclaimer: No content published on this website is intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. Seek advice from your physician or other qualified healthcare providers with questions you may have regarding your symptoms and medical condition for a complete medical diagnosis. Do not delay or disregard seeking professional medical advice because of something you have read on this website. Read our Editorial Process to know how we create content for health articles and queries.

This website uses cookies to ensure you get the best experience on our website. iCliniq privacy policy