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Erysipelas in Adult
See also in: Cellulitis DDx,Anogenital
Other Resources UpToDate PubMed

Erysipelas in Adult

See also in: Cellulitis DDx,Anogenital
Contributors: Christopher Iriarte MD, Tara Mahar MD, Art Papier MD, Susan Burgin MD
Other Resources UpToDate PubMed


Erysipelas is a superficial bacterial infection of the skin most often caused by beta-hemolytic group A streptococci (Streptococcus pyogenes). It involves the lymphatics of the superficial dermis. Erysipelas has a predilection for individuals at the extremes of age, debilitated patients, and those with poor lymphatic drainage. Erysipelas can occur on the face but is more commonly seen on the lower extremities of patients with venous insufficiency and stasis dermatitis.

Clinically, it presents as a strikingly red, well-demarcated plaque that is very tender. Burning paresthesias may be present. Commonly involved areas are the face, extremities, and penis. Erysipelas may occur in tattoos. Cutaneous findings are usually preceded by abrupt onset of fever, chills, nausea, and malaise. Lymphadenopathy is almost always present. Trauma to the skin is thought to be an important factor in the development of erysipelas; therefore, a concomitant dermatophyte infection, surgical incision, ulceration, insect bite, or inflammatory skin condition may provide a portal of entry for bacteria. The nasopharynx is often the reservoir in cases of facial erysipelas. Additional predisposing factors for erysipelas include alcohol use disorder, diabetes, immunocompromised states, and nephrotic syndrome.

Penile erysipelas responds to treatment with antibiotics but tends to recur, causing a progressive, chronic lymphedema with permanent swelling of the penis (elephantiasis). Lymphedema and elephantiasis may also develop in the lower extremities from recurring bouts of erysipelas.


A46 – Erysipelas

44653001 – Erysipelas

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Last Reviewed:11/12/2020
Last Updated:11/12/2020
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Patient Information for Erysipelas in Adult
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Erysipelas is a skin infection caused by a bacteria called Streptococcus pyogenes. This bacteria may enter the body through an injury to the skin, such as a surgical incision, an insect bite, or another skin condition.

The infection causes a rash that is bright red and may burn, itch, sting, and/or swell. It may blister.

Erysipelas most often occurs on the arms and legs, but is sometimes seen on the face. Men can get it on their genitals.

Who’s At Risk

Older adults and those who are immunocompromised are more likely to get erysipelas. This includes people with diabetes or kidney disease and people who abuse alcohol.

Signs & Symptoms

The rash looks like bright red, smooth patches that are tender and warm to the touch. It may burn or tingle.

Self-Care Guidelines

Rest and elevate the affected area, if possible. Cold washcloths on the rash may ease the burning and itching.

When to Seek Medical Care

If the rash spreads to your eyelids or if you develop fever and chills, contact your doctor.


Your doctor might prescribe an antibiotic to kill the infection.
Copyright © 2023 VisualDx®. All rights reserved.
Erysipelas in Adult
See also in: Cellulitis DDx,Anogenital
A medical illustration showing key findings of Erysipelas : Fever, Face, Lymphangitis, Painful skin lesions, Scrotum, Skin warm to touch, Blanching patch, WBC elevated, Malar distribution
Clinical image of Erysipelas - imageId=175775. Click to open in gallery.  caption: 'A close-up of a deeply erythematous, edematous, and vesiculated patterned plaque on the buttock.'
A close-up of a deeply erythematous, edematous, and vesiculated patterned plaque on the buttock.
Copyright © 2023 VisualDx®. All rights reserved.