Erysipelas
Basics
Description
- Distinct form of cellulitis: an acute, well-demarcated, superficial bacterial skin infection (most commonly on face or leg) with lymphatic involvement almost always caused by Streptococcus pyogenes
- Usually acute, but a chronic recurrent form can also exist
- Nonpurulent
- System(s) affected: skin, exocrine
Epidemiology
- Predominant age: infants, children, and adults aged >45 years
- Greatest in elderly (aged >75 years)
- No gender/racial predilection
Incidence
- Erysipelas occurs in ~24/1,000 persons/year (1).
- Incidence on the rise since the 1980s
Prevalence
Unknown
Etiology and Pathophysiology
- Group A streptococci induce inflammation and activation of the contact system, a proinflammatory pathway with antithrombotic activity, releasing proteinases and proinflammatory cytokines.
- The generation of antibacterial peptides and the release of bradykinin, a proinflammatory peptide, increase vascular permeability and induce fever and pain.
- The M proteins from the group A streptococcal cell wall interact with neutrophils, leading to the secretion of heparin-binding protein, an inflammatory mediator that also induces vascular leakage.
- This cascade of reactions leads to the symptoms seen in erysipelas: fever, pain, erythema, and edema.
- Group A β-hemolytic streptococci primarily; commonly Streptococcus pyogenes, occasionally, other Streptococcus groups C/G
- Rarely, group B streptococci/Staphylococcus aureus may be involved.
Risk Factors
- Disruption in the skin barrier (surgical incisions, insect bites, eczematous lesions, local trauma, abrasions, dermatophytic infections, intravenous drug user [IVDU])
- Chronic diseases (diabetes, malnutrition, nephrotic syndrome, heart failure)
- Immunocompromised (HIV)/debilitated
- Fissured skin (especially at the nose and ears)
- Toe-web intertrigo and lymphedema
- Leg ulcers/stasis dermatitis
- Venous/lymphatic insufficiency (saphenectomy, varicose veins of leg, phlebitis, radiotherapy, mastectomy, lymphadenectomy)
- Alcohol abuse
- Morbid obesity
- Recent streptococcal pharyngitis
- Varicella
General Prevention
- Good skin hygiene
- It is recommended that predisposing medical conditions, such as tinea pedis and stasis dermatitis, be appropriately managed first.
- Men who shave within 5 days of facial erysipelas are more likely to have a recurrence.
- With recurrences, search for other possible sources of streptococcal infection (e.g., tonsils, sinuses).
- Compression stockings should be encouraged for patients with lower extremity edema.
- Consider suppressive prophylactic antibiotic therapy, such as penicillin, in patients with >2 episodes in a 12-month period.
Pediatric Considerations
Group B Streptococcus may be a cause of erysipelas in neonates/infants.
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Citation
Domino, Frank J., et al., editors. "Erysipelas." 5-Minute Clinical Consult, 33rd ed., Wolters Kluwer, 2025. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116216/all/Erysipelas.
Erysipelas. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116216/all/Erysipelas. Accessed November 7, 2024.
Erysipelas. (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116216/all/Erysipelas
Erysipelas [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2025. [cited 2024 November 07]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116216/all/Erysipelas.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - Erysipelas
ID - 116216
ED - Domino,Frank J,
ED - Baldor,Robert A,
ED - Golding,Jeremy,
ED - Stephens,Mark B,
BT - 5-Minute Clinical Consult, Updating
UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116216/all/Erysipelas
PB - Wolters Kluwer
ET - 33
DB - Medicine Central
DP - Unbound Medicine
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