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

Erysipelas in Child

See also in: Cellulitis DDx
Contributors: Christopher Iriarte MD, Lori Prakash DO, Noah Craft MD, PhD, 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 usually occurs in isolation and has a predilection for the extremes of age, debilitated patients, and patients with poor lymphatic drainage. Erysipelas can occur on the face but is more commonly seen on the lower extremities of adults with venous insufficiency and stasis dermatitis. In children, the scalp, face, and hands are the most common sites of involvement, although it may occur anywhere. Neonates present more commonly with rapidly spreading periumbilical erythema.

Clinically, the infection presents as a strikingly red, well-demarcated plaque that is very tender. Burning paresthesias may be present. Cutaneous findings are usually preceded by abrupt onset of fever, chills, nausea, and malaise. In neonates and infants, poor feeding, irritability, and lethargy may accompany erysipelas. 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 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). Elephantiasis may also develop in the lower extremities from recurring bouts of erysipelas.

If not treated promptly, complications in children include meningitis, septicemia, endocarditis, toxic shock, and necrotizing fasciitis.


A46 – Erysipelas

44653001 – Erysipelas

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Differential Diagnosis & Pitfalls

  • Cellulitis
  • Preseptal cellulitis / Orbital cellulitis
  • Toxic shock syndrome
  • Nummular dermatitis
  • Arthropod bite or sting
  • Erythema migrans (see Lyme disease)
  • Necrotizing fasciitis
  • Acute Allergic contact dermatitis
  • Drug reactions
  • Deep vein thrombosis
  • Skin bacterial abscess
  • Omphalitis of the newborn
  • Juvenile gangrenous vasculitis of the scrotum
  • Herpes zoster

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Last Reviewed:11/12/2020
Last Updated:12/07/2020
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Erysipelas in Child
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.