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Erysipelas – Causes, Symptoms and Treatment

Erysipelas is an acute bacterial skin infection causing sharply defined redness, swelling, and pain. It requires prompt antibiotic treatment to prevent complications.

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Things worth knowing about "Erysipelas"

Erysipelas is an acute bacterial skin infection causing sharply defined redness, swelling, and pain. It requires prompt antibiotic treatment to prevent complications.

What is Erysipelas?

Erysipelas is an acute bacterial infection of the skin and superficial lymphatic vessels. It is one of the most common skin infections worldwide and most frequently affects the lower legs and the face. The condition is characterized by a rapidly spreading, sharply demarcated area of redness and swelling. Without prompt treatment, erysipelas can progress to serious complications.

Causes

Erysipelas is caused primarily by beta-hemolytic Group A Streptococci (Streptococcus pyogenes). Less commonly, other streptococcal groups or staphylococci may be responsible. The bacteria enter the skin through small breaks such as cuts, cracks, insect bites, or fungal infections of the foot (tinea pedis).

Risk factors that increase susceptibility include:

Chronic fungal infections of the feet (athlete's foot)
Lymphedema or chronic venous insufficiency
Weakened immune system (e.g., due to diabetes mellitus or immunosuppressive therapy)
Obesity
Previous episodes of erysipelas (tendency to recur)

Symptoms

Erysipelas typically develops rapidly, beginning with systemic symptoms followed by characteristic skin changes:

Systemic symptoms: High fever (often above 39 °C / 102 °F), chills, fatigue, and headache
Local skin symptoms: Sharply demarcated, fiery red, raised, warm, and painful skin area that spreads quickly
Swollen lymph nodes near the affected region
In severe cases: blistering (bullous erysipelas) or skin hemorrhages

Diagnosis

Erysipelas is usually diagnosed clinically based on its characteristic appearance and the medical history. Additional diagnostic tests may include:

Blood tests: elevated inflammatory markers (CRP, white blood cell count, ESR)
Blood cultures: to rule out sepsis (bloodstream infection)
Skin swab (occasionally, in atypical presentations)
Ultrasound: to exclude deeper infections such as necrotizing fasciitis

Treatment

The primary treatment for erysipelas is antibiotic therapy targeting streptococcal bacteria:

Penicillin is the first-line antibiotic – given orally for mild cases and intravenously for severe cases or complications
Alternatives for penicillin-allergic patients: clindamycin or erythromycin
Duration of treatment: typically 10–14 days

Supportive measures include:

Elevation of the affected limb to reduce swelling
Cooling compresses applied to the affected area
Rest during the acute phase of illness
Treatment of the entry site (e.g., athlete's foot) to reduce the risk of recurrence

Complications and Recurrence

If left untreated or inadequately managed, erysipelas can lead to serious complications including abscess formation, necrotizing fasciitis (a life-threatening deep tissue infection), or sepsis. Because erysipelas damages lymphatic vessels, recurrent episodes are common. In patients with frequent relapses, long-term prophylaxis with low-dose penicillin may be considered.

References

Stevens D.L., Bisno A.L. et al. - Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections. Clinical Infectious Diseases, 2014.
Chira S., Miller L.G. - Staphylococcus aureus is the most common identified cause of cellulitis: a systematic review. Epidemiology and Infection, 2010.
World Health Organization (WHO) - Antimicrobial resistance and skin infections: global guidelines, 2022.

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