Erysipelas: Information & Recommended Erysipelas Specialists

Erysipelas is a bacterial skin infection. It typically affects the upper layers of the skin and the lymphatic vessels. Common sites where erysipelas can occur are the face and the lower legs. In principle, however, this skin condition can occur anywhere.

In everyday language, erysipelas is called “red fever.” This name comes from the external symptoms associated with the condition: the affected area becomes red and sometimes severely swollen.

The inflammation spreads around the site where the pathogen entered the body. The colloquial name “rose sore” refers to the fact that this spread can visually resemble the bloom of a rose.

In some cases, erysipelas is characterized not only by skin redness and swelling, but also by blisters and pustules.

It is a bacterial infection usually caused by streptococci. Even the tiniest wounds in the skin are enough for these bacteria to gain access to the body. If they are very small, these wounds do not have to be visible on the surface.

For example, even a seemingly harmless case of athlete’s foot can serve as a gateway for these bacteria. The infection can then spread into the deeper layers of the skin and into the lymphatic spaces. The inflammation of the skin is ultimately a defensive reaction by the body as it attempts to fight off the invading bacteria.

It’s not just minor skin injuries that pose a risk of developing erysipelas. People with

• venous disorders,
• lymphedema, or
• diabetes mellitus, as well as
• circulatory disorders in the legs

are also considered part of the high-risk group. Patients with immune system problems are also at risk. The same applies to smokers.

Skin redness and swelling are characteristic features of erysipelas. However, the actual inflammation begins earlier. The affected person may feel tired and run-down. Fever and chills may also accompany this general feeling of malaise.

The external signs usually do not appear until a few days later. Inflammation spreads around the site where the bacteria entered the body. This is followed by the typical redness and swelling of the skin.

Due to the inflammation, there may also be

• significant warmth in the skin as well as
• tenderness in the area of redness with
• pus formation (medical term: phlegmon) and 
• the formation of small blisters,
• a painful, reddened streak (medical term: lymphangitis), and 
• swelling of the lymph nodes

may occur. 

Erysipelas on the leg © GordonGrand | AdobeStock

A medical examination is important to assess the severity of the condition. This also allows other diseases to be ruled out and the appropriate treatment to be initiated. The pathogens are often undetectable, but a trained physician will be able to recognize erysipelas based on its external appearance.

Antibiotics are the treatment of choice for erysipelas. If the patient is in very poor health, antibiotics can also be administered intravenously. Otherwise, they are given in tablet form (medically: orally). Penicillin is frequently prescribed to combat streptococci. If this antibiotic is not tolerated (most commonly due to a penicillin allergy), clindamycin or erythromycin may be prescribed as alternatives.

In addition, the patient must, of course, take it easy. Bed rest is recommended in many cases where the condition is very severe. However, care should be taken to prevent thrombosis (abdominal injections).

If the erysipelas is located on the lower leg, it may be helpful to elevate the affected leg. This improves lymphatic drainage and helps reduce swelling. In addition, cooling, moist dressings with antiseptic solutions are often helpful. They alleviate symptoms, reduce swelling and inflammation, and lower the bacterial count.

If pain is present, appropriate medications can be prescribed to make the course of the illness a little more bearable. Compression therapy or blood thinners are also recommended as supportive measures, especially in cases of limited mobility.

Important: In cases of erysipelas, the underlying cause must always be investigated. If, for example, skin diseases or other chronic conditions are present, they should be treated concurrently to prevent the risk of recurrence (a return of erysipelas).

Although erysipelas sometimes resolves on its own, in the worst-case scenario, serious complications can arise.

For example, lymphatic vessels can become blocked, which can lead to lymphedema because fluid can no longer drain properly. Elephantiasis, which can be considered the end stage of lymphedema, is also possible. This involves massive soft-tissue swelling, which in the case of elephantiasis is generally permanent (irreversible) and cannot be reversed. 

Other complications of untreated or inadequately treated erysipelas include

• phlebitis
• kidney problems, or
• sepsis (blood poisoning)
• spread to other organs
• Thrombosis of the superficial or deep veins

Surgery is extremely rare in cases of erysipelas. Ultimately, it may be indicated if large abscesses form that need to be drained. Otherwise, the pathogens may spread, particularly via the bloodstream, leading to blood poisoning. This complication must be taken extremely seriously and can be fatal.

In isolated cases, significant tension in the tissue within the muscle sheaths (fascia) may also necessitate an incision in the fascia to prevent tissue necrosis. However, this complication is also rare and is generally not necessary.

The loss of a limb as a result of erysipelas is an absolute rarity, and the risk actually exists only when other serious medical conditions are present.

For example, advanced peripheral arterial disease—which typically involves narrowing or blockages of the leg arteries, leading to impaired blood flow to the tissues—may initially present as erysipelas.

If this circulatory problem cannot be resolved, or if the tissue damage is already too advanced, amputation may be indicated in extreme cases. However, this is very rare and is caused not by the inflammation of the tissue itself, but primarily by the vascular disease.