Erysipelas affects the outer layer of your skin, while cellulitis affects the inner layers. Erysipelas typically has more defined borders on the skin, while cellulitis can cause more systemic symptoms.

Cellulitis and erysipelas are bacterial skin infections. They can both affect any area of your body but usually involve the feet and lower legs.

Erysipelas affects your epidermis, the topmost layer of your skin. It may also affect nearby lymph nodes.

Cellulitis affects the dermis, the inner layers of your skin. It may also spread into the tissues, tendons, and muscles below the dermis layer.

This article discusses the causes, symptoms, and treatments for cellulitis and erysipelas. It also explains who’s most at risk of these infections.

Cellulitis and erysipelas result from bacteria that get into the skin. While it’s not always possible to determine how bacteria enter your skin, they often do so through an opening like a cut, oozing rash, or open sore. Abrasions, burns, and surgical wounds are all prone to infection from these bacteria.

Several types of bacteria can cause erysipelas. It’s most commonly due to group A Streptococcus bacteria. Streptococcus is also responsible for infections like strep throat and impetigo (skin sores). Staphylococcus bacteria (which cause staph infections) may also cause erysipelas, although this is less common.

Group A Streptococcus is also the most common cause of cellulitis, but Staphylococcus aureus is also a common cause.

Are erysipelas and cellulitis contagious?

While the bacteria that cause erysipelas and cellulitis are very contagious, erysipelas and cellulitis aren’t. The bacteria need to enter your skin to cause the infection, so person-to-person contact typically doesn’t lead to either condition.

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Anyone can get cellulitis or erysipelas. You may be more likely to develop an infection if you have a weakened immune system. People who routinely inject medications may also have a higher chance of getting both infections.

Chronic edema (swelling) from lymphedema and other conditions tends to increase your risk of cellulitis. If you’ve had a coronary bypass that involved using a healthy vein grafted from a leg, you may also be at greater risk.

If you get piercings or tattoos, infections like cellulitis and erysipelas can sometimes occur.

Having a skin condition involving blisters or sores can also increase your likelihood of getting both infections, especially if you scratch or break your skin. Some common skin conditions that may lead to cellulitis or erysipelas infections include:

Erysipelas affects the upper skin layers, usually on the lower legs or feet. It can also develop on the face. Affected skin is usually swollen and appears shiny and discolored. The affected skin can also be painful or tender to the touch.

An erysipelas infection tends to have clearly defined borders. If the infection spreads or worsens, you may see blisters or streaks stretching out from the borders. You may also run a fever.

Cellulitis typically occurs on the lower legs and feet but can occur anywhere on your body. This infection causes your skin to look dark red or purple. Unlike erysipelas, a cellulitis infection has soft borders that aren’t well-defined.

Since cellulitis affects the inner layers of your skin, it may generate pus. Pain and swelling are common. Fever is less common but may also occur.

Treatment for cellulitis and erysipelas involves antibiotic medication. If your condition is mild, a healthcare professional can prescribe oral antibiotics. They may give you intravenous (IV) antibiotics in a hospital setting for more severe cases.

A healthcare professional may also recommend external antibacterial wraps if cellulitis is severe.

Which antibiotics a doctor prescribes can depend on the type of bacteria causing the infection. Since most cellulitis and erysipelas cases are due to group A Streptococcus or Staphylococcus, doctors often use medications that are effective against both types of bacteria, such as:

To determine whether the antibiotic works, a healthcare professional may draw a ring around the infection to see whether it spreads past that border. If so, they may try a different antibiotic or treatment.

While rare, cellulitis that spreads deep into the skin sometimes requires surgery to remove dead tissue and pus.

Erysipelas vs. cellulitis vs. necrotizing fasciitis

Erysipelas, cellulitis, and necrotizing fasciitis are all due to bacterial infections. Erysipelas and cellulitis are common. Necrotizing fasciitis is rare.

Erysipelas and cellulitis cause mild to moderate symptoms. These conditions require treatment to avoid complications like sepsis and gangrene. However, they aren’t typically life threatening.

In contrast, necrotizing fasciitis, commonly known as flesh-eating bacteria, can quickly become a life threatening disease.

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Cellulitis and erysipelas require antibiotic treatment to resolve. Without treatment, serious complications may occur.

If you have symptoms of either condition, let a healthcare professional know. Contact a doctor as soon as possible if symptoms like pain, discoloration, or swelling worsen or spread.

Erysipelas and cellulitis typically resolve with treatment. However, it’s common for either condition to occur again.

If you have a history of cellulitis or erysipelas and notice the reappearance of symptoms, let a healthcare professional know. In most cases, oral antibiotics may be enough to keep either infection in check.

Erysipelas and cellulitis are bacterial infections of the skin. Cellulitis affects the inner layers of your skin. Erysipelas affects the outer layer.

Treatment for both conditions includes oral or IV antibiotics.