Erysipelas

Written by Helen Colledge and Marijane Leonard | Published on July 25, 2012
Medically Reviewed by George Krucik, MD

Erysipelas

Overview

Erysipelas is a bacterial infection in the upper layer of your skin. It is similar to another skin disorder known as cellulitis, an infection in the lower layers of your skin. In practice, it is almost impossible for doctors to tell the difference between the two conditions, but this is not a problem as they are treated in the same way. Erysipelas occurs most frequently in the legs but also commonly affects the face.

Causes of Erysipelas

Erysipelas is caused by bacteria penetrating the outer barrier of your skin. The bacteria that most commonly cause erysipelas are known as streptococci, and they normally live on your skin and other body surfaces without causing harm. They can, however, enter your skin through a cut or a sore. Conditions that cause breaks in the skin, such as athlete’s foot and eczema, can sometimes lead to erysipelas.

In addition to openings in the skin, anything that prevents blood or fluid draining from an area of your body can make erysipelas more likely to occur.

In cases where your face is affected, the bacteria may have spread there from your nasal passages following an infection in your nose and throat.

The list of causes includes:

  • cuts and ulcers in your skin
  • surgical incisions
  • insect bites
  • athlete’s foot
  • skin conditions such as eczema and psoriasis
  • obesity
  • swollen legs due to health problems such as heart failure
  • uncontrolled diabetes
  • injecting illegal drugs
  • anything that suppresses the immune system
  • having had a previous episode of erysipelas

Who Is at Risk for Erysipelas?

Those who are very young or very old are most at risk for the condition, with those over 60 being most likely to develop erysipelas. Elderly people whose immune systems are compromised or who have problems with fluid building up after surgery have the greatest risk.

What are the Symptoms of Erysipelas?

Before the symptoms of erysipelas develop, you may notice you have a cut, insect bite, or a nose and throat infection. However, it is more likely that you will not notice any of these things before symptoms arise. Erysipelas symptoms typically include:

  • fever
  • chills
  • generally feeling unwell
  • a red, swollen, warm, and painful area of skin with a raised edge
  • blisters on the affected area
  • swollen glands

On the face, the red swollen area of erysipelas usually covers the nose and both cheeks.

Diagnosing Erysipelas

It is likely that your doctor will be able to diagnose erysipelas by its appearance alone.

Treating Erysipelas

If you are in otherwise good health, you may be able to remain at home during your erysipelas treatment. Some cases require treatment at a hospital.

Home Care

Usually, the affected body part must be raised higher than the rest of your body to reduce swelling. If your leg is affected, you should aim to rest as much as possible with the leg elevated above your hip. For example, lie down, and prop your leg up on some cushions. It is important to get up and walk about from time to time and to keep up your fluid intake. You may have to keep your leg elevated for several days before the swelling resolves.

Medication

Antibiotics, such as penicillin, are the usual treatment for erysipelas. For a less severe case, you may be able to take an oral prescription at home, and the course usually lasts for a week. More serious illnesses are generally treated at the hospital, where antibiotics can be administered into intravenously. Very young or elderly patients may also require treatment in a hospital. Occasionally, the bacteria do not respond to the antibiotic, and it is necessary to try a different drug.

You may be given painkillers to reduce discomfort and treat any fever.

Antifungal medication for athlete’s foot may be necessary if this is the cause of your erysipelas.

Surgery

Surgery is only needed in rare cases of erysipelas that have progressed and caused healthy tissue to die. An operation might then be required to cut away the dead tissue.

Long-Term Outlook

For most people, antibiotics will successfully treat erysipelas within a week. It can take longer than a week for the skin to appear normal, and it may peel. The infection may recur in a minority of patients.

Without treatment, you may be at risk of complications such as:

  • an abscess
  • blood clots
  • gangrene
  • blood poisoning, where infection spreads throughout your blood stream
  • infected heart valves
  • joint and bone infections

If you have erysipelas near your eyes, the infection could spread to your brain.

Prevention

Although erysipelas cannot be prevented in all cases, you can take the following steps to lower your risk:

  • Always keep wounds clean.
  • Treat athlete’s foot if you have it.
  • Use moisturizers to prevent skin from drying and cracking.
  • Try not to scratch your skin.
  • Make sure any skin problems such as eczema are adequately treated.
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