Erysipelas and cellulitis

At a glance

  • If there's a break in your skin, bacteria can get in and cause pain, redness and swelling.
  • An infection of only the outer layers of skin is called erysipelas.
  • If deeper layers are infected too, it is called cellulitis.
  • Both of these infections are most common on the lower legs and feet.
  • They can be treated with antibiotics.

Introduction

Photo of a patient and doctor at the hospital

Erysipelas and cellulitis are skin infections that can develop if enter through a break in the skin. Both infections make your skin swell, become red and tender. Erysipelas (also known as St. Anthony's fire) only affects the outer layers of skin and lymph vessels. Cellulitis reaches deeper layers of tissue. If the right treatment is started early enough, both kinds of infections usually clear up without any lasting effects.

Despite having a similar name, cellulitis has nothing to do with the more widely known but harmless “cellulite.”

Symptoms

Both infections are most common on the feet or lower legs, but they may also occur in other areas of the body. Erysipelas can develop on the face, and cellulitis may also occur on the palm of the hand, for instance.

Erysipelas

Erysipelas affects the outer layers of the skin. It typically leads to painful swelling in a quite clearly defined area of skin. On lighter skin, this area looks shiny and light red. Red streaks leading from that area may be a sign that the has started to spread along the lymph vessels too. On darker skin, the redness is less noticeable or can't be seen at all. The darker the skin, the harder it is to see. In more severe cases of erysipelas, blisters may form as well.

Nearby lymph nodes sometimes swell up and hurt when touched. People usually have a fever and feel generally unwell right from the start of the .

This photorealistic illustration shows a lower leg with erysipelas (left). The outer layers of skin are red and inflamed.

Cellulitis (deeper infection of connective tissue)

Unlike erysipelas, the caused by cellulitis reaches deeper layers of skin and the connective tissue beneath it. It can spread along tendons and muscles, and pus may form. If any redness can be seen, the area is less clearly defined than in erysipelas. On lighter skin it often looks dark red or light purple in color.

Like in erysipelas, the affected skin and connective tissue is typically swollen and painful in cellulitis. But people are less likely to develop a fever or feel unwell. That might happen in more serious cases of cellulitis, though.

This photorealistic illustration shows a lower leg with cellulitis (left). The infection has reached deeper layers of skin and tissue.

Causes and risk factors

Both types of infections are caused by bacteria that get in through breaks in the skin. Erysipelas is often caused by streptococcus , while cellulitis is typically caused by staphylococcus . Both types of can cause either erysipelas or cellulitis, though.

Damage to the surface of the skin makes it easier for to get in. Because of this, the risk factors include

The risk of is particularly high if you have a weakened immune system – for example, as a result of taking certain medications. These include some cancer drugs, steroids, and medications that are used in the treatment of autoimmune diseases like rheumatoid arthritis (to suppress the body's immune response).

Various other health problems can also increase the risk of developing erysipelas or cellulitis. These include diabetes, being very overweight, problems with the drainage of lymph fluid or the circulation of blood, and venous insufficiency. People who have had erysipelas or cellulitis in the past are more likely to develop it in the future.

Good to know:

Erysipelas and cellulitis are both not contagious.

Prevalence

Erysipelas and cellulitis are among the most common skin conditions, but it's not known exactly how often they occur. According to some studies, 2 out of 10,000 people are affected each year. Other research suggests that more than 250 out of 10,000 people are affected.

Effects

If left untreated, bacterial skin infections can lead to various complications. These include the following:

  • The spread of pus-producing and abscesses: Especially in cellulitis, the with pus can spread to deeper tissue (such as muscle tissue). Sometimes the pus builds up in natural spaces or gaps between tissue, leading to abscesses.
  • Lymphedema: The infected lymphatic vessels may be badly damaged in some places after an erysipelas . Then the lymph fluid can't drain properly, causing it to build up. That leads to a permanent swelling known as lymphedema. The blood circulation in the tissue becomes worse as a result, increasing the risk of another bacterial skin .

Life-threatening complications are rare. If enter the bloodstream, they may cause blood poisoning (septicemia). In very rare cases, a bacterial skin on the face can cause meningitis ( of the membranes covering the brain and spinal cord) or a blood clot in one of the blood vessels in the brain (cerebral venous thrombosis).

If there are complications, they have to be treated fast. Signs of a more severe include

  • severe pain,
  • fever, cold sweats, pale skin,
  • nausea,
  • a faster rate of breathing or a racing heart, and
  • drowsiness, confusion, or other problems affecting consciousness or awareness.

Important:

If you notice any of these signs of serious complications, it is important to call the emergency services immediately (112 in Germany and many other countries, 911 in the U.S.).

Diagnosis

Doctors can usually tell whether an is erysipelas or cellulitis based on the typical symptoms. The appearance of the skin is often enough to make a clear , particularly on lighter skin. Your medical history or recent injuries often help to diagnose the problem too.

Further tests aren't usually needed. Sometimes the fluid from the wound is tested for germs. Knowing exactly what kind of is causing the can be important for the treatment.

Prevention

People who have had erysipelas or cellulitis in the past are more likely to develop the same kind of in the future – even after successful treatment. About one third of people who have had an erysipelas get it again.

Avoiding damage to your skin is one way to reduce the risk. If a skin condition like athlete’s foot or made it easier for the to occur in the first place, it is a good idea to treat that condition first. People who have diabetes or blood circulation problems are more likely to have injuries on their feet and legs. That also increases their risk of infections in those places. So it's important for them to take good care of their feet.

If bacterial skin infections keep occurring, preventive treatment with may be considered. The are then taken daily over a number of months.

Treatment

Erysipelas and cellulitis are both treated with antibiotics like penicillin. The medication is delivered directly into a vein using a drip. In milder cases, the can be taken in the form of tablets instead. People who go to the hospital for treatment usually have to stay for about a week.

The choice of antibiotic will depend on several factors, like what type of the doctor thinks you have (or what type of they have identified). To check if the treatment is working, the healthcare professional outlines the visible area of infected skin with a special pen. That way, they can see if the is starting to go away and the are helping.

Doctors also recommend that you cool the swelling and apply moist antiseptic (germ-killing) dressings. Anti-inflammatory painkillers like ibuprofen can help to reduce pain and fever.

If the is on your face, it's better to speak or chew as little as possible. If the skin on a leg or foot is infected, it's a good idea to keep that leg raised. Bed rest is even recommended in many cases.

In severe cellulitis, surgery is needed in order to remove pus and dead tissue.

Further information

When people are ill or need medical advice, they usually go to see their family doctor first. Information about health care in Germany can help you to navigate the German healthcare system and find a suitable doctor. You can use this list of questions to prepare for your appointment.

Dalal A, Eskin-Schwartz M, Mimouni D et al. Interventions for the prevention of recurrent erysipelas and cellulitis. Cochrane Database Syst Rev 2017; (6): CD009758.

Deutsche Dermatologische Gesellschaft (DDG), Deutsche Gesellschaft für Wundheilung und Wundbehandlung (DGfW), Deutsche Gesellschaft für Lymphologie (DGL) et al. S1-Leitlinie Differentialdiagnose akuter und chronischer Rötungen im Bereich der Unterschenkel. AWMF-Registernr.: 013-100. 2021.

Holm N, Burgdorf WH. Hauterkrankungen bei dunkelpigmentierten Menschen. In: Plewig G, Degitz K (Ed). Fortschritte der praktischen Dermatologie und Venerologie, vol 17. Berlin: Springer; 2001.

Kilburn SA, Featherstone P, Higgins B et al. Interventions for cellulitis and erysipelas. Cochrane Database Syst Rev 2010; (6): CD004299.

Moll I. Duale Reihe Dermatologie. Stuttgart: Thieme; 2016.

Mukwende M, Tamony O, Turner M. Mind the gap: A handbook of clinical signs in black and brown skin. London: St George's University; 2020.

Oh CC. Cellulitis and erysipelas: prevention. BMJ Clin Evid 2015: pii: 1708.

Oh CC, Ko HC, Lee HY et al. Antibiotic prophylaxis for preventing recurrent cellulitis: a systematic review and meta-analysis. J Infect 2014; 69(1): 26-34.

Phoenix G, Das S, Joshi M. Diagnosis and management of cellulitis. BMJ 2012; 345: e4955.

Quirke M, Ayoub F, McCabe A et al. Risk factors for nonpurulent leg cellulitis: a systematic review and meta-analysis. Br J Dermatol 2017; 177(2): 382-394.

Stevens DL, Bisno AL, Chambers HF et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis 2014; 59(2): e10-52.

Stevens DL, Bryant AE. Impetigo, Erysipelas and Cellulitis. National Center for Biotechnology Information (National Library of Medicine; NIH) 2016.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

Comment on this page

What would you like to share with us?

We welcome any feedback and ideas - either via our form or by gi-kontakt@iqwig.de. We will review, but not publish, your ratings and comments. Your information will of course be treated confidentially. Fields marked with an asterisk (*) are required fields.

Please note that we do not provide individual advice on matters of health. You can read about where to find help and support in Germany in our information “How can I find self-help groups and information centers?

Über diese Seite

Updated on July 8, 2025

Next planned update: 2028

Publisher:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

Stay informed

Subscribe to our newsletter or newsfeed. You can find our growing collection of films on YouTube.