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Erysipelas and cellulitis are the same? Symptoms, causes, and treatment- Erysipelas

Erysipelas is a skin infection with its singular traits. Here you will find out everything on erysipelas and its contrasts with cellulitis. Erysipelas is usually confused with cellulitis. And, each disease has its causes, complications, and treatment. Therefore, the importance of discerning between them.

For an experienced doctor, it should be easy to differentiate them. It is not the case for the general population. Let me guide you through the scientific background of this disease for you to obtain doctor’s insights on this skin infection.

What is the skin?

The skin is the primary barrier the body has to defend from foreign microorganisms. It has healthy bacteria populating it that would also help with the protection role. However, the skin is one of the primary sites of infection in the human body. In fact, nearly always, the same bacteria manage to surpass the skin defense mechanisms.

The skin division is into three layers epidermis, dermis, and hypodermis, from shallow to deep, respectively. Underneath those layers, there are vessels, nerves, and fatty tissue. These structures are the subcutaneous tissue and support the healthy development of the three skin layers.

Furthermore, this organization is essential for the understanding of skin diseases because it mostly relies on where the infection is. If it is superficial or deep, it will define its severeness and possible complications.

File:501 Structure of the skin.jpg
Skin structure
OpenStax College / CC BY (

What are erysipelas and cellulitis?

Erysipelas is an acute infection of the skin that involves the epidermis and the upper portion of the dermis. It is a characteristic of the disease to affect the lymphatic vessels causing swelling of the lymph nodes. The bacteria cause this infection and very often is Streptococcus pyogenes.

On the other hand, cellulitis is an inflammation that involves all three layers of the skin, the subcutaneous tissue, mostly by an acute infection. Even though both conditions are skin infections, erysipelas is considered to be superficial, while cellulitis is profound and can exist due to multiple microorganisms.

What is erysipelas caused by?

The primary cause of erysipelas is streptococcus bacteria. However, this bacterium has many types that can affect; besides that, other bacteria may cause this infection too. The most probable microorganism involved would depend on the patient’s characteristics and the site of the infection and how the skin lesion looks.

The facial infections are mostly by Streptococcus pyogenes, which is the same bacteria involved in the strep throat or the bacterial sore throat. There other types of streptococcus, and they have its importance as the Streptococcus agalactiae. This other streptococcus, besides S. pyogenes, causes erysipelas infection in the leg and specifically, the bacteria I just told you, S. agalactiae, has particular significance on newborns’ infection.

The role of a bacterium, Staphylococcus aureus, in cellulitis is evident, not that much in erysipelas. Only in a special presentation of the disease, bullous erysipelas, the toxins of this bacteria plays a leading role in worsening the infection. Nevertheless, the S. aureus causing an infection by direct invasion as the streptococcus does has no evidence for now.

Who are the most at risk?

Erysipelas mostly affects children and the elderly; therefore, its implication chiefly consists of the extremes of life, and from them, the ones prone to have this infection are the ones presenting the following risk factors. People with chronic edema or lymphedema, cardiovascular conditions (as hypertension), patients who had breast surgery due to cancer, people with a weakened immune system (diabetes, cancer, or human immunodeficiency virus), nephrotic syndrome, and people in a homeless situation.

Cellulitis is much more widespread among the population in comparison to erysipelas. The exact numbers of each one of them, for now, are not possible to have because these diseases are not of an obligatory report to the health authorities. However, a study in Utah had an estimation of twenty-five cases per 1000 people each year. The people above forty-five years had more risk of developing it.

For both diseases, people with a weakened immune system (taking oral steroids or with diabetes, for example), a decrease in the arterial blood flow or venous insufficiency of the lower limbs. Nearly all the risk factors are the same between them and end in more danger of developing any of the infections.

What are the symptoms of this infectious disease?

Erysipelas causes a typical skin lesion, which is a vivid red rash that is very demarcated from the surrounding skin. The infection of the external ear is odd, but when it occurs, it is particular of this condition. On the contrary, cellulitis skin lesion is redness (or erythema) and tenderness of the skin, with inadequately defined margins. The margin demarcation of the lesion is the cornerstone for differentiating between them. Cellulitis is deeper; therefore, it cannot sharply define the lesion borders as erysipelas do.

Furthermore, erysipelas is a disease that traditionally affected the face. Still, these days, a transition of the infection site towards the legs due to many factors is a fact—opposing to cellulitis that can widely affect the body.

Approximately 48 hours earlier in the skin area where the erysipelas infection will appear, it can exist symptoms as itching, burning, tenderness, and swelling. Later on, erysipelas’ lesion may be in association with ulceration, blisters, purulent discharge, swelling, and pus collection. Also, it tends to present with bothering body symptoms such as malaise, chills, and high fever. Very often, before the skin lesion even exists. Other symptoms may be muscle ache, nausea, vomits, and headache.

What are the complications of erysipelas?

Usually, erysipelas infection after a course of oral antibiotics has fewer complications and threatening scenarios than cellulitis. However, indeed, there are situations in which difficulties may arise, mostly in patients with risk factors.

The complications could be localized to the skin or widespread throughout the body, and in severe cases, they can cause death. The list includes abscess, amputation, chronic erysipelas, bacteria dissemination in the body, scarlet fever, pneumonia, central nervous system infection, and embolism; the most common of them are abscess, gangrene, and vein inflammation (thrombophlebitis).

One of the most feared skin complications is necrotizing fasciitis; it requires immediate medical care because it substantially increases the mortality in these patients. Its principal characteristic is the black coloring of the affected skin. It requires intravenous antibiotics plus surgical care of the wound.

Sadly, recurrent erysipelas could occur in one of every five patients; therefore, the patient would repeatedly have this infection. Mostly in patients with underlying risk factors. This situation can lead to local complications within the leg, which are disabling, such as elephantiasis.

How the doctor diagnose erysipelas?

The classic presentation of erysipelas leaves no doubt. Therefore, with just the history and body examination would be enough to diagnose the disease. Nor blood tests or microbiological cultures of tissue samples are necessary in the vast majority of the cases.

However, a blood count will show an elevation of the white blood cell count. And in other laboratory workups, an increase in inflammation blood markers as erythrocyte sedimentation rate and C-reactive protein, although conventional to find they are not specific to this illness. The imaging exams are ordered if your doctor is thinking about an underneath complication or a more in-depth spread of the infection.

Patients with a doubtful presentation of the disease may benefit from a bacterial culture. This exam consists of taking a sample of the skin lesion and cultivating it in a special medium to see which bacteria are within the wound. Despite that not always brings positive results; when positive, it confirms the infection and identifies the microorganism causing it.

What is the treatment for erysipelas?

Adequate medical management would resolve most of erysipelas without any complication. The treatment comprises symptoms of relief and antibiotics.

The relief of symptoms is through drugs and techniques that include things you would find at home. The aches and fever would pass with the use of over the counter pain killers as acetaminophen or ibuprofen. Then, mindful rehydration of the patient is mandatory due to the fluid loss that is occurring because of the fever. The local maneuvers such as cold compresses usage, elevation and rest of the affected limb, and wet dressings (which are changed in a mean of every 6 hours), would help to reduce the limb inflammation and in the bettering of both symptoms.

The antibiotics remain the cornerstone of the therapy. Given that, streptococci are the bacteria that most cause erysipelas. The best antibiotic is the good and old penicillin, oral antibiotic therapy for five days is more than enough. However, if the infection is not resolved, treatment should be extended.

In extreme cases, when necrosis occurs (black coloring of the skin – necrotizing fasciitis) where there is an accelerated death of the tissue, a surgical procedure is advised for taking care of the wound. Also, if the patient has severe symptoms, intravenous antibiotics, and hospitalization is recommended for close monitoring.

How do you prevent erysipelas?

Firstly, patients that have had a previous erysipelas infection should be taught how to care for a wound and how to clean it. Also, patients with predisposing skin lesions as tinea pedis or ulcers should receive medical therapy for avoiding possible infections.

In patients at high risk, the use of antibiotic prophylaxis is a common practice. This prevention means taking a low dose of antibiotics for an extended period to avoid the possible scenario of bacteria growing. It is also with penicillin and could be either orally or intramuscular in a variable schedule.

How does erysipelas looks?

File:Facial erysipelas.jpg
Facial erysipelas.
CDC/Dr. Thomas F. Sellers/Emory University / Public domain
File:Érysipèle jambe- Leg erysipelas - profil.jpg
Leg erysipelas.
Grook Da Oger / CC BY-SA (

What should you do if you are presenting symptoms?

This tool is an erysipelas symptoms checker. It would help you to assess how likely it is that your symptoms are indeed by this condition. It is free, and would only take a few minutes!

What do you think?

Written by Dr. Esteban Kosak

Doctor of Medicine - MD Recently Graduated from Medical School and inspired to aid the global population during this situation. I think that we shall no longer be waiting to see a doctor when we feel sick. Several times we feel disease searches in Google drive us to a rabbit hole and come out thinking that we may die of cancer or something very serious, given that symptoms may seem to fit a wide variety of illnesses. Since I recently graduated from medical school. I have all the medical information fresh in my mind. My thorough experience as an expert researcher allows me to very-well known the different diseases and conditions that affect human bodies. Empowered by the United Nations 17 Sustainable Development Goals (SGDs). I think that we all can provide a grain of sand to help humanity. That's why we created Symptoms.Care a place where you can come and screen your symptoms and find what different illnesses can be related to them. Armed with the right information you can instantly, discretely, secure and from the comfort of your home talk with a Doctor that can Evaluate your Symptoms and help you seek the right treatment.


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