Erysipelas: Symptoms, Causes, Treatment
الحُمَّرة (Erysipelas)
Erysipelas is a bacterial infection of superficial skin and nearby lymphatic vessels, often causing a painful, hot area with a distinct border. It needs clinician-selected antibiotics and urgent assessment when there are signs of spread.
What is Erysipelas?
It commonly affects a leg but can involve the face or other sites. It overlaps with cellulitis, while eczema and venous swelling can cause noninfectious redness. A red leg is not automatically erysipelas.
Related reading: Skin abscess and diffuse skin infection.
Symptoms
Pain, warmth, swelling and sharply bordered redness may occur, sometimes with blisters, fever, chills and fatigue. Redness may be less visible on darker skin; warmth, tenderness, swelling and change from usual skin color remain important.
Causes
Bacteria, commonly streptococci, enter through a fissure, wound or fungal infection between the toes. The entry point may be difficult to see. Impaired lymphatic or venous drainage contributes to recurrence.
Risk factors
Lymphedema, venous insufficiency, wounds, ulcers, foot fungus and immune suppression increase risk. A previous episode raises recurrence risk, but recurrent redness still requires diagnostic review rather than automatic antibiotics.
Diagnosis
Diagnosis usually relies on examination and the time course. Severe illness or suspected systemic spread may need blood tests, and atypical findings require consideration of alternatives. Biopsy or culture is not necessary for every uncomplicated case.
Treatment
Antibiotic choice, route and duration depend on location, severity, allergy history and medical circumstances; oral or intravenous treatment may be appropriate. Rest, limb elevation and suitable pain relief help. Steroid alone or an arbitrary ointment cannot replace prescribed antibiotic care.
Complications
Infection may spread to blood or deeper tissue and may recur with lymphatic problems. Skin changes can persist after fever improves, but worsening or spreading pain needs review rather than being assumed normal recovery.
Prevention
Care for cracks and wounds, treat foot fungus and manage chronic swelling and diabetes. Preventive antibiotics are not automatic; specialists consider them for selected recurrent cases after addressing risk factors. The team advises when limb compression is appropriate.
When to see a doctor
Seek prompt care for painful hot swelling, especially near the eye or with fever. Confusion, fainting, rapid breathing or disproportionate pain is an emergency. Reassessment is needed for worsening or no initial improvement within two to three days of treatment.