Erysipelas Causes and Risk Factors

Pathogenic Organisms

Beta-hemolytic streptococci, particularly Streptococcus pyogenes (group A), are the predominant causative organisms of erysipelas, which enter through breaches in the skin 1
Less commonly, other streptococci groups (B, C, G) may cause erysipelas, according to the Infectious Diseases Society of America 2
Staphylococcus aureus is a rare cause of erysipelas, usually associated with previous penetrating trauma, as reported by the Clinical Infectious Diseases journal 2
Other rare infectious agents can cause cellulitis/erysipelas in specific circumstances, including Pasteurella species or Capnocytophaga canimorsus following cat or dog bites, Aeromonas hydrophila after immersion in fresh water, Vibrio species after saltwater exposure, and Streptococcus iniae or Erysipelothrix rhusiopathiae, as stated by the Clinical Infectious Diseases journal 2

Trauma to the skin, even minor and clinically inapparent breaks, can lead to erysipelas, as noted by the Clinical Infectious Diseases journal 3, 4
Preexisting skin infections such as impetigo or ecthyma can increase the risk of erysipelas, according to the Clinical Infectious Diseases journal 4
Ulceration, inflammatory dermatoses such as eczema, and fissured toe webs from maceration or fungal infection can also contribute to the development of erysipelas, as reported by the Clinical Infectious Diseases journal 2, 4

Previous cutaneous damage and venous insufficiency can increase the risk of erysipelas, as stated by the Clinical Infectious Diseases journal 3

Procedures that disrupt lymphatic drainage, such as saphenous venectomy, axillary node dissection for breast cancer, and operations for gynecologic malignancies involving lymph node dissection, can increase the risk of erysipelas, according to the Clinical Infectious Diseases journal 2

Erysipelas is characterized by sudden onset with fever preceding skin manifestations, rapidly spreading areas of edema, redness, and heat, and painful, infiltrated, erythematous plaque with distinct borders, as described by the Clinical Infectious Diseases journal 3
The skin surface may resemble orange peel due to superficial cutaneous edema, and vesicles, bullae, and cutaneous hemorrhage may develop, as reported by the Clinical Infectious Diseases journal 3
Lymphangitis and inflammation of regional lymph nodes may also occur, according to the Clinical Infectious Diseases journal 3

Erysipelas typically presents with a rapidly spreading, well‑demarcated area of intense erythema, edema, warmth, and tenderness, accompanied by a raised border; systemic fever often precedes the skin changes. 5

The infection is distinguished by sharply demarcated, raised borders that clearly separate affected from unaffected skin. 5
A “peau d’orange” (orange‑peel) appearance may be seen due to superficial edema surrounding hair follicles, producing characteristic skin dimpling. 5
Intense erythema with associated swelling, tenderness, and warmth spreads rapidly over hours to days. 5
In more severe cases, vesicles, bullae, and cutaneous hemorrhage (petechiae or ecchymoses) may develop. 5

Facial involvement is the second most common site of erysipelas after the lower extremities. 5

Fever is typically present and may occur hours before the skin abnormalities appear. 5
Severe disease can be accompanied by tachycardia, confusion, and hypotension. 5

Visible red streaking along lymphatic channels (lymphangitis) may be observed. 5
Tender, enlarged regional lymph nodes (regional lymphadenopathy) draining the affected area are common. 5

Erysipelas must not be confused with purulent infections (e.g., abscesses, furuncles, septic bursitis); the term should be reserved for diffuse, spreading infections without pus collections, guiding treatment toward antibiotics rather than drainage. 5