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Erysipelas is a type of superficial cellulitis (see Bacterial Skin Infections: Cellulitis) with dermal lymphatic involvement.

Erysipelas should not be confused with erysipeloid, a skin infection caused by Erysipelothrix (see Gram-Positive Bacilli: Erysipelothricosis). Erysipelas is characterized clinically by shiny, raised, indurated, and tender plaque-like lesions with distinct margins. There is also a bullous form of erysipelas. Erysipelas is most often caused by group A (or rarely group C or G) β-hemolytic streptococci and occurs most frequently on the legs and face. However, other causes have been reported, including Staphylococcus aureus (including methicillin-resistant S. aureus [MRSA]), Klebsiella pneumoniae, Haemophilus influenzae, Escherichia coli, S. warneri, Streptococcus pneumoniae, S. pyogenes, and Moraxella sp. Erysipelas of the face must be differentiated from herpes zoster, angioedema, and contact dermatitis. It is commonly accompanied by high fever, chills, and malaise. Erysipelas may be recurrent and may result in chronic lymphedema.

Erysipelas

Diagnosis is by characteristic appearance; blood culture is done in toxic-appearing patients. Diffuse inflammatory carcinoma of the breast may also be mistaken for erysipelas.

Treatment of choice is penicillin V 500 mg po qid for ≥ 2 wk. In severe cases, penicillin G Some Trade Names
BICILLIN
WYCILLIN
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1.2 million units IV q 6 h is indicated, which can be replaced by oral therapy after 36 to 48 h. Dicloxacillin Some Trade Names
DYCILL
DYNAPEN
PATHOCIL
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500 mg po qid for 10 days can be used for infections with staphylococci. Erythromycin Some Trade Names
ERY-TAB
ERYTHROCIN
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500 mg po qid for 10 days may be used in penicillin-allergic patients; however, there is growing macrolide resistance in streptococci. In infections resistant to these antibiotics, cloxacillin Some Trade Names
No US trade name
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or nafcillin Some Trade Names
UNIPEN
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can be used. In Europe, pristinamycin and roxithromycin have been shown to be good choices for erysipelas. If MRSA is suspected, empiric coverage should be initiated. Cold packs and analgesics may relieve local discomfort. Fungal foot infections may be an entry site for infection and may require antifungal treatment to prevent recurrence.

Last full review/revision October 2007 by A. Damian Dhar, MD

Content last modified October 2007