Erysipelas Uncovered: When Red Flags Mean More Than Red Skin

What Is Erysipelas?

A superficial form of cellulitis, erysipelas primarily affects the upper dermis and lymphatics. It’s most commonly caused by Streptococcus pyogenes (Group A Strep), but its striking appearance makes it clinically distinct.

You’ll usually see:

• Bright red, well-demarcated, raised lesions

• Sudden onset of fever, chills, and malaise

• Affected areas that are warm, tender, and sometimes edematous

Think cheeks, legs, and sometimes arms, especially in patients with underlying lymphedema or skin barrier damage.

How It Spreads

Erysipelas thrives when the skin barrier is compromised. Transmission is not as contagious as impetigo, but certain risk factors increase susceptibility:

• Skin trauma, ulcers, or surgical wounds

• Athlete’s foot or interdigital fissures

• Chronic venous insufficiency or lymphedema

• Immunocompromised states

While direct person-to-person spread is rare, outbreaks have occurred in hospital settings through shared linens or contact with colonized skin.

Why It Matters

Erysipelas is more than a red rash: it’s a clinical emergency when systemic symptoms escalate.

Complications may include:

• Bacteremia or sepsis

• Recurrence (especially in patients with lymphedema)

• Abscesses or necrosis if misdiagnosed or untreated

It’s often confused with:

• Classic cellulitis (deeper and less demarcated)

• Contact dermatitis

• Facial lupus (in butterfly-pattern facial involvement)

• Angioedema or insect bites

What helps?

• Sharp clinical observation

• CBC and CRP (often elevated)

• Blood cultures in febrile patients

• Immediate antibiotic therapy (such as penicillin or cefazolin)

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