Erysipelas – Bacterial Infection: History, Symptoms, Causes

Streptococcus Pyogenes: the primary bacterium causing this infection

It is a bacterial skin infection that affects the upper dermis that characteristically extends to superficial skin lymphatics.

It is a soft plaque, intensely erythematous, indurated, with a delimited border.

Its well-defined margin can help differentiate it from other skin infections (e.g., cellulitis).

Erysipelas goes back to the Middle Ages, where it was called the fire of San Antonio, named for the Christian saint to whom the afflicted would appeal for healing.

Around 1095, the Order of Saint Anthony, a Roman Catholic congregation, was formed in France to care for those with the ailment.

Several diseases were probably grouped under this eponymous, including ergotism and herpes zoster (shingles).


Historically, erysipelas occurred on the face, but nowadays, cases often involve the legs.

Streptococcus pyogenes group A streptococcal bacteria causes most facial infections; Although it can also cause erysipelas in the legs, an increasing percentage of lower extremity infections are caused by streptococci not belonging to group A.

Patient education

Patients should rest, elevate the affected area and use cold compresses four times a day for 48 hours.

They should see a primary care doctor if they experience increased pain, fever, chills, flushing, or other new symptoms.

Erysipelas is a bacterial infection in the upper layer of the skin. It is similar to another skin disorder known as cellulitis, a condition in the lower layers of the skin.

Both conditions are similar in appearance and are treated in the same way.

Erysipelas is usually caused by the Streptococcus bacteria of Group A, the same bacteria that causes strep throat.

The infection results in large red spots on the skin. This is sometimes accompanied by other symptoms, such as blisters, fevers, and chills. Erysipelas occurs most often on the face and legs.

What are the symptoms?

The symptoms of erysipelas typically include:

  • Fever.
  • Cold.
  • Generally, it feels terrible.
  • A red, swollen, painful skin area with a raised border.
  • Blisters in the affected area.
  • Swollen glands
  • When erysipelas affects the face, the swollen area usually includes the nose and both cheeks.

What causes erysipelas?

Erysipelas occurs when Group A Streptococcus bacteria penetrate the outer skin barrier.

These bacteria usually live on your skin and other surfaces without causing any damage. However, they can enter your skin through a cut or sore and cause an infection.

Conditions that cause breaks in the skin, such as athlete’s foot and eczema, can sometimes lead to erysipelas.

Erysipelas can also occur when the bacteria spread to the nasal passages after an infection in the nose and throat.

Other causes include:

  • Ulcers on the skin
  • Surgical incisions
  • Insect bites.
  • See your skin conditions, such as psoriasis.
  • Swollen legs due to health problems, such as heart failure and diabetes.
  • The injection of illegal drugs, such as heroin.

Risk factor’s

Young children (mainly 2 to 6 years old) and adults over 60 are more likely to develop erysipelas.

Older adults who have weak immune systems or problems with fluid buildup after surgery are at the most significant risk.


The doctor can usually diagnose erysipelas simply by performing a physical examination and asking about the symptoms.

During the exam, the doctor will check for swollen, reddened, warm areas of the skin on the face and legs.

The doctor may also ask if you have recently had another type of infection or have suffered a minor injury, such as a cut or scrape.

Clinical characteristics of Erysipelas

The symptoms and signs of erysipelas are usually abrupt in the beginning and often accompanied by fevers, chills, and tremors.

Erysipelas predominantly affects the skin of the lower limbs. Still, when it comes to the face, it can have a characteristic distribution of the butterfly on the cheeks and across the nose bridge.

  • The affected skin has a very sharp, raised edge.
  • It is bright red, firm, and swollen.
  • It can be blistered, and it can become necrotic in severe cases.
  • Cellulite does not usually have such a marked swelling but shares other characteristics with erysipelas, such as pain and heat gain of the affected skin.
  • In infants, it often occurs in the navel or diaper region.
  • Bullous erysipelas may be due to coinfection with Staphylococcus aureus (including MRSA).


Most people with erysipelas can be treated at home, but some may require treatment at a hospital.

Depending on the severity of the condition, the treatment plan may include home remedies, medications, or surgery.

Home care

In general, the affected part of the body must be elevated higher than the rest of your body to reduce swelling.

For example, if your leg is affected, you should rest as much as possible with the leg raised above the hip.

You can support your leg on some cushions while lying down. It is also essential to drink plenty of fluids and get up and walk from time to time.

It is possible to keep the leg elevated for several days before the swelling disappears.


The antibiotics, such as penicillin, are the most common treatment for erysipelas. You may be able to take an oral prescription at home if you have a mild case of erysipelas.

You probably have to take medicine for a week.

The most severe cases of erysipelas are usually treated in the hospital, where antibiotics can be given through an intravenous (IV).

Young children and older adults may also need treatment in a hospital. Occasionally, the bacteria do not respond to the antibiotic, and it is necessary to try another type of drug.

Analgesics can also be given to reduce discomfort and treat fever.

Antifungal medication for athlete’s foot may be required if this is the cause of the infection.


Surgery is only required in rare cases that have progressed rapidly and caused healthy tissue to die. A surgical operation may be necessary to cut the dead tissue.

What is the long-term perspective of someone with this disease?


For most people, antibiotics will successfully treat erysipelas within a week. However, it may take more than a week for the skin to return to normal.

People who have continued episodes of this infection may need long-term preventive antibiotic treatment.

Without treatment, you may be at risk for several complications, including:

  • An abscess
  • Blood clots.
  • Gangrene refers to the death of body tissue.
  • Blood poisoning occurs when the infection spreads through your bloodstream.
  • It infected heart valves.
  • Articular and bone infections.
  • It is also possible that the infection spreads to your brain if you have erysipelas near your eyes.


Although erysipelas can not always be prevented, you can take the following steps to reduce the risk:

  • Always keep the wounds clean.
  • Treat athlete’s foot if you have it.
  • Use moisturizers to prevent the skin from drying out and cracking.
  • Ensure that any skin problems, such as eczema are treated effectively.
  • You can also prevent future incidences of erysipelas by attending follow-up appointments with your doctor.

Erysipelas often improves with treatment. In general, the infection can be treated effectively with antibiotics.

What are the complications?

Erysipelas is repeated in up to a third of patients due to:

  • Persistence of risk factors.
  • Lymphatic damage (therefore, impaired drainage of toxins).
  • Complications are rare but may include:
  • Abscess.
  • Gangrene
  • Thrombophlebitis.
  • Chronic inflammation of the legs.
  • Infections distant to the erysipelas site:
  • Infective endocarditis (heart valves).
  • Septic arthritis.
  • Bursitis.
  • Tendinitis.
  • Post-streptococcal glomerulonephritis (kidney disease that affects children).
  • Thrombosis of the cavernous sinus (dangerous blood clots that can spread to the brain).
  • Streptococcal toxic shock syndrome (rare).

The perspective of the disease

While the signs of general illness resolve within a day or two, skin changes can take a few weeks to resolve fully. There are no scars.

Long-term preventive treatment with penicillin is often required for recurrent attacks of erysipelas.

Erysipelas is repeated in up to one-third of patients due to the persistence of risk factors and also because erysipelas itself can cause lymphatic damage (hence the damaged drain of toxins) on the involved skin that predisposes to new attacks.

Long-term preventive treatment with penicillin can be considered if patients have recurrent attacks.