Erysipelas

Overview

Erysipelas (say 'air-ih-SIP-uh-lus') is a bacterial skin infection. It affects the upper layers of the skin and the tissue just below it. It usually causes a bright red, swollen, warm, and painful area with a clear, raised border. It often appears on the lower leg or face. It is treated with antibiotics from a healthcare professional.

It is a common skin infection, especially in adults. It is less common in children.

Symptoms

Common symptoms

• A bright red area of skin that feels warm and tender
• Swelling and a raised, clearly defined edge
• Pain or soreness in the area
• Fever, chills, or feeling generally unwell
• Tender, swollen glands near the area
• Sometimes small blisters or a shiny, tight look to the skin

Symptoms in children

• Fever, irritability, or poor feeding
• A red, warm, painful patch, often on the face or leg
• Crying with touch or movement of the area
• Vomiting or feeling very tired

Symptoms in older adults

• Fever may be low or missing, while confusion or unusual sleepiness can be a sign
• Leg swelling that gets worse, with red, warm skin
• More risk of serious illness, so same-day advice is important
• Skin may look dry, thin, or easily damaged

Causes

Main causes

• Bacteria entering through a small break in the skin, such as a cut, scrape, insect bite, cracked skin, or athlete's foot
• A type of strep bacteria is the usual cause
• Sometimes other bacteria can cause a similar infection

Risk factors

• Swelling in the legs (lymphedema) or poor vein flow
• Diabetes
• A weakened immune system
• Eczema, psoriasis, or other skin conditions that break the skin
• Injury, surgery, or insect bites
• Being overweight
• Previous erysipelas
• Alcohol misuse or poor nutrition

When to see a doctor

See a doctor urgently if:

• You have a fever with a new red, painful, warm area of skin
• The redness is on the face or around the eye
• You have diabetes, a weakened immune system, or poor circulation and think you have a skin infection
• The redness is spreading quickly or you feel very unwell
• You are not improving after a day or two of treatment

Book a routine appointment if:

• You have had erysipelas before and want advice on prevention
• A red area is slowly getting better but you have questions
• You need help managing leg swelling or skin care
• You want to check that a skin problem is healing as expected

Diagnosis

A healthcare professional can usually diagnose erysipelas by looking at and feeling the skin, asking about symptoms, and checking for fever. The sharp border and warm, red, swollen area are typical.

Tests that may be done

• Blood tests if you are very unwell or have other health conditions
• A swab or skin sample if the skin is broken or the diagnosis is unclear
• An ultrasound scan if there is concern about a blood clot or a deep collection of pus
• Tests to check blood sugar or other health problems if needed

What to expect at your appointment

The visit is usually quick. Your clinician will check the area, ask about pain and fever, and may mark the edge of the redness to see if it spreads. They will explain treatment and when to get follow-up.

Treatment

Erysipelas is treated with antibiotics prescribed by a healthcare professional. Rest, raising the affected limb, and good skin care help recovery. Most people start to feel better within a few days, but it is important to finish the full course.

Self-care at home

• Rest and raise the affected arm or leg on a pillow when possible
• Drink plenty of fluids
• Keep the skin clean and gently pat it dry
• Avoid scratching, picking, or squeezing the area
• Use a cool, clean cloth for comfort if it feels hot
• Take pain or fever relief only as advised by your pharmacist or clinician
• Watch the edge of the redness and note if it spreads

Medical treatments

A healthcare professional will usually prescribe antibiotic tablets or, if you are very unwell, antibiotics through a drip in hospital. They may also advise treatment for swelling, skin conditions, or other health problems that raise your risk. Do not use leftover antibiotics or share them with others.

When is surgery considered?

Surgery is rarely needed. It may be considered if an abscess or dead tissue develops, or if the infection does not respond to treatment.

Living with this condition

Recovery usually takes days to a couple of weeks. Keep taking the antibiotics as directed, even if you feel better. Check the skin each day and ask for advice if redness spreads or you feel worse.

Lifestyle tips

• Manage leg swelling with movement, elevation, and compression if your clinician advises it
• Keep skin moisturized and treat cracked skin or athlete's foot
• Wear comfortable shoes and avoid walking barefoot where injury is likely
• Maintain a healthy weight if it helps your leg health
• Stop smoking if you smoke, as it affects circulation and healing

Diet and exercise

Eat a balanced diet and drink enough fluids. Gentle movement helps circulation. If you have leg swelling, ask your clinician which exercises and compression are safe for you.

Mental health and emotional wellbeing

A painful skin infection can be worrying, and repeated episodes can be frustrating. It is okay to feel anxious or low. Talk to your clinician about support. If you feel overwhelmed or have thoughts of harming yourself, contact your local crisis service or emergency number right away.

Prevention

You cannot always prevent erysipelas, but good skin care and managing risk factors can lower the chance. Treat cuts and scrapes promptly, keep skin clean and moisturized, and get help for swollen legs or skin conditions.

Vaccines

There is no vaccine for erysipelas. Keep up with routine vaccines recommended for your age and health, and ask your clinician if you are unsure.

Screening programmes

There is no screening test for erysipelas. If you have repeated infections, your clinician may check for underlying causes such as leg swelling or diabetes.

Complications

If left untreated

• The infection can spread deeper into the skin and tissue
• An abscess or pocket of pus can form
• The infection can enter the bloodstream and make you very unwell
• Dead tissue can develop, which is rare but serious
• Repeated episodes can damage lymph vessels and cause lasting leg swelling
• Scarring or skin changes can occur

Long-term outlook

With prompt treatment, most people recover fully. Some people get erysipelas again, so it is wise to learn about skin care and ask for advice on prevention. Getting care early gives the best chance of a smooth recovery.

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