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

Erysipelas in Adult

See also in: Cellulitis DDx
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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Differential Diagnosis & Pitfalls

  • Cellulitis
  • Unilateral facial erysipelas can be confused with Herpes zoster.
  • Erysipelas of the leg can be confused with Stasis dermatitis.
  • Fixed drug eruption
  • Acute Allergic contact dermatitis is usually pruritic.
  • Lyme disease
  • Orbital cellulitis
  • Erythema nodosum
  • Thermal or electrical burn
  • Deep vein thrombosis
  • Acute febrile neutrophilic dermatosis (Sweet syndrome)
  • Polyarteritis nodosa
  • Cutaneous presentations of breast cancer
  • Eosinophilic cellulitis (Wells syndrome)
  • Necrotizing fasciitis
  • Angioedema
  • Lymphedema
  • Urticaria
  • Erysipeloid
  • Familial Mediterranean fever
  • Vasculitis
  • Cryptococcosis
  • Chemical Cellulitis
  • Juvenile gangrenous vasculitis of the scrotum

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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 in Adult
See also in: Cellulitis DDx
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 © 2024 VisualDx®. All rights reserved.