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Clinical Summary

Erysipelas is a group A streptococcal cellulitis (groups G, B, C, and D can be implicated as well as other bacteria causing an erysipelas-like infection) involving the skin; the infection is more superficial than cellulitis. The most affected sites are the face and the lower extremities. Sudden onset of fever, chills, and malaise is followed by the appearance of an erythematous, edematous, and painful plaque. The characteristic border is sharp and elevated. This nonpitting edematous plaque is different from typical cellulitis due to dilation of the superficial lymphatics. Regional lymphadenopathy and lymphangitis may be present. Patients with chronic lymphedema are prone to repeated infections.

Management and Disposition

All infections require rest, elevation, and antibiotics. Mild presentations may be treated on an outpatient basis with oral penicillins. More severe illness or toxicity requires hospitalization and IV antibiotics.


  1. The sharp elevated border is diagnostic of erysipelas.

  2. A similar shiny, erythematous (although more violaceous) plaque on the face of a febrile child may be caused by Haemophilus influenzae type B in nonimmunized or immunosuppressed individuals.

  3. Consider this diagnosis in any patient with chronic lymphedema.

FIGURE 13.23

Erysipelas. Sharply demarcated and elevated erythema. (Photo contributor: David Effron, MD.)

FIGURE 13.24

Erysipelas. Note the well-demarcated, edematous, erythematous, shiny plaque. (Photo contributor: Department of Dermatology, Wilford Hall USAF Medical Center and Brooke Army Medical Center, San Antonio, TX.)

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