Treatments and Preventive Measures of Erysipelas | Dermatology


What is erysipelas?

Erysipelas is a type of skin infection. Erysipelas is an infection (surface) of the epidermis. The most common cause is group A streptococcal bacteria, especially streptococcus pyogenes. This is a deep red rash with raised edges, easily recognizable by the surrounding skin. The injured skin may be hot to the touch.

At one time, erysipelas was thought to primarily affect the face, but recent studies suggest that the distribution of inflammation is changing, with the legs currently involved in nearly 80% of cases. The rash can also appear on the hands or trunk.

Alternate name

  • St. Anthony’s fire

Causes of erysipelas

It is caused by a bacteria called Streptococcus pyogenes, which also causes pharyngitis (sore throat) and strep throat. The face and hands are most affected because a person with strep throat brings coughs and viruses to the skin.

It occurs when bacteria enter the skin through cuts, abrasions, or other breaks and spread rapidly through small lymphatic vessels below the surface of the skin. In an attempt to neutralize bacteria, the immune system launches an inflammatory attack that causes local blood vessels to rupture and tissue to swell.

In some cases, bacteria can penetrate the skin without compromise if there is pre-existing lymphedema (such as after a radical mastectomy to remove lymph nodes). Without a lymphatic system to isolate disease-causing germs, the skin is more prone to infection.

Risk factors

Older people with weakened immune systems or who have fluid retention problems after surgery is at the highest risk. The risk factors include:

  • Broken skin, including cuts, abrasions, insects bites, ulcers, animal bites, and burns
  • Immune deficiency
  • Eczema
  • Psoriasis
  • Athlete’s foot
  • Venous insufficiency
  • Diabetes
  • Being overweight
  • Lymphedema
  • Strep throat
  • Prior history of this disease

Symptoms of erysipelas

The symptoms typically include:

  • Fever
  • Chills
  • Generally feeling unwell
  • A red, swollen, and sensitive area of skin with a raised edge
  • Blisters on the affected area
  • Swollen glands

Diagnosis of erysipelas

The diagnosis of erysipelas is by symptom; Blood culture is performed in patients who appear toxic.

Erysipelas of the face must be distinguished from herpes zoster, angioedema, and contact dermatitis. Diffuse inflammatory breast cancer can also be confused with erysipelas.

Treatment for erysipelas

The standard treatment for erysipelas is antibiotics. Penicillin is often the first-line treatment option for streptococcal infections. Other antibiotics may be used if you are allergic to penicillin.

  • Cephalosporin-class antibiotics
  • Clindamycin (brand names Cleocin, Clindacin, Dalacin)
  • Dicloxacillin (brand names Dycill, Dynapen)
  • Erythromycin (brand names Erythrocin, E-Mycin, Ery-Tab)
  • Azithromycin (brand names Zithromax, AzaSite, Z-Pak)

In most cases, it can be treated by mouth instead of intravenous (IV) antibiotics. Any pain, swelling, or discomfort can be treated with rest, cold compresses, and elevation of the affected limb. Nonsteroidal anti-inflammatory drugs such as Advil (ibuprofen) or olive (naproxen) can be used to relieve pain and fever.


Surgery is required only in rare cases of erysipelas where healthy and rapidly developing tissue dies. A surgical operation may be required to amputate the dead tissue.

Prevention of erysipelas

  • Since erysipelas is caused by cracks in the skin, it is advisable to take good care of it by cleaning it regularly. In such cases, the use of antiseptics or humectants is preferred.
  • Always keep wounds clean and dry
  • Avoid scratching the affected area if you have any skin conditions
  • Treat skin problems like eczema or athlete’s foot right away.


In some cases of cellulitis, bacteria can trigger a secondary infection in other parts of the body, such as in the blood (septicemia).

Blood poisoning can be fatal and often requires hospitalization for treatment with intravenous antibiotics (antibiotics are given directly into a vein)

Other complications can include:

  • Abscesses
  • Necrotizing fasciitis: A rare bacterial infection of the deepest layer of the skin, causing the death of affected tissue.
  • Facial cellulitis: Which can lead to meningitis if untreated

Departments to consult for this condition

  • Department of dermatology

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