Erysipelas

Reviewed by Dr John Pillinger, GP and Dr Janice Main, senior lecturer and honorary consultant physician in infectious diseases and general medicine

What is it?

Erysipelas is an acute infection of the skin and underlying fat tissues, usually caused by the streptococcus bacteria.

Who is at most risk?

This highly unpleasant condition is most common in elderly people. It is also seen in the very young, and in people with immune-deficiency (due to HIV or cancer of the components of the blood for example).

A breach in the skin surface is a common route into the body for infectious organisms. Because of this, eczema, or even a small scratch, especially in the area around the ear or in the auditory passage can lead to erysipelas.

People with a leg ulcer or fungal infection on the foot are at increased risk, as these conditions weaken the normal defence mechanisms of the skin and make it easier for the bacteria to invade.

What are the symptoms?

The symptoms of erysipelas usually arise quite suddenly.

A small red area appears on the skin. Within a few hours it expands markedly.

The infection spreads like a wave beneath the skin, creating a raised border between the infected area and the surrounding, healthy skin.

The less dense tissue underneath the skin (fat tissue) is particularly prone to infection. In the facial area, the inflamed spot is typically found on the cheeks and around the eyes and ears.

The development of the infection is accompanied by chills, high fever and headaches. Without effective antibacterial treatment, the patient may feel quite unwell.

When should the doctor be called?

If you suspect erysipelas, you should always call your doctor. Treatment with penicillin will quickly reduce infection and prevent the onset of dangerous complications.

Which medicines can be used?

Penicillin V taken orally (as tablets or a syrup).

Benzylpenicillin injection.

Flucloxacillin (as tablets, syrup, intramuscular injections or intravenous infusions).

Erythromycin is an alternative to penicillin for people who have a penicillin allergy.

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