Erysipelas is an acute bacterial infection of the upper layers of the skin and nearby lymphatic vessels. It is a form of superficial cellulitis, usually caused by streptococcal bacteria. The infection can worsen quickly and requires prompt medical assessment and antibiotic treatment.
Symptoms
Erysipelas usually begins suddenly. The affected skin becomes painful, hot, swollen and firm, with a clearly defined raised edge. It often affects a lower leg or the face. On lighter skin the area may look bright red. On brown or black skin, redness may be less visible and the area may appear purple, grey or darker than the surrounding skin.
- Rapidly expanding painful and warm skin
- Swelling with a sharply defined border
- Fever, chills, headache or feeling generally unwell
- Swollen and tender lymph nodes
- Blisters in some cases
Causes and risk factors
Bacteria can enter through a cut, ulcer, insect bite, surgical wound, cracked skin or fungal infection between the toes. Sometimes the opening is too small to see. Risk is higher in people with lymphoedema, leg swelling, poor circulation, diabetes, obesity, a weakened immune system or a previous episode of erysipelas or cellulitis.
Erysipelas is not the same as a simple allergic rash. A painful, hot and expanding area of skin needs medical assessment even when the color change is difficult to see.
Diagnosis and treatment
A healthcare professional usually diagnoses erysipelas from the appearance of the skin and the symptoms. Tests may be needed when the person is severely unwell, the diagnosis is uncertain or another complication is suspected.
Antibiotics are required. Mild infection may be treated with tablets, while severe infection, facial involvement or significant illness may require hospital care and antibiotics through a vein. Take every dose as directed and complete the prescribed course. Contact the treating service if symptoms do not start to improve within two or three days, or if they worsen at any time.
Rest, fluids and elevation of an affected arm or leg can reduce swelling. A suitable pain reliever may help, but check with a pharmacist or clinician if you have other conditions, take medicines, are pregnant or are treating a child.
Urgent and emergency warning signs
Seek urgent same day medical care for a painful, hot and swollen area of skin that is spreading, particularly when it is accompanied by fever or general illness.
Call local emergency services immediately if there is a very high temperature, rapid breathing, a fast heartbeat, dizziness, fainting, confusion, cold or clammy skin, purple patches, severe weakness or loss of consciousness. Severe pain that seems out of proportion to the visible skin changes also requires emergency assessment.
Reducing the risk of recurrence
Keep skin clean and moisturised, treat cracks and wounds promptly, and manage conditions that cause swelling. Check between the toes for fungal infection and seek treatment when needed. People with repeated episodes should discuss prevention and underlying risk factors with a healthcare professional.
Related information
Read more about bacterial and fungal conditions in our Infections and Skin Health sections. Related pages include impetigo and ringworm.
Sources
Using this information
This information supports general understanding and preparation for a conversation with a qualified healthcare professional. It does not replace an individual medical assessment, diagnosis or treatment.
Reviewed: 28 August 2026