Find Out More About Treating Erysipelas

Penicillin is mainly used for the treatment of this skin disease. Do you want to know why? Read on to find out!
Find Out More About Treating Erysipelas

Last update: 04 February, 2021

Treating erysipelas isn’t so hard. Interestingly, the term dermo hypodermitis is now used in France to distinguish erysipelas, a skin disease that attacks not only the dermis but also the underlying lymphatic vessels.

Below we’ll tell you more about this disease, its possible causes, treatment, and other interesting facts.

What is erysipelas?

As previously mentioned, erysipelas is a disease that affects the dermis and underlying lymphatic vessels. Its caused by the group A Streptococcus bacteria, which is the same bacteria that causes strep throat.

The disease usually affects mainly the skin of the legs, although it can also affect other areas, such as the face, for example. Consequently, each case will be different.

A leg with erysipelas.

According to the MSD Manual, this disease can be recurrent and cause chronic lymphedema. Therefore, medical consultation is essential, as well as subsequent treatment and follow-up of the disease. If not treated in time, complications can include thrombophlebitis, abscesses, and gangrene.


When the group A streptococcus bacteria penetrate the exterior barrier of the skin, erysipelas occurs. To a lesser extent, group G and C streptococci are responsible.

These bacteria normally live on the skin and other surfaces without resulting in any harm. However, the bacteria can enter the skin through cuts or sores, resulting in an infection.

Conditions that imply breaks in the skin, like athlete’s foot and eczema, can sometimes lead to erysipelas. Erysipelas can also occur when bacteria spreads through the nasal channels after a nose or throat infection.


The main symptoms of erysipelas are the following:

  • Chills
  • General discomfort
  • High fever (which appears suddenly)
  • Skin problems, which tends to be red, swollen with raised edges
    • Blisters may also occur in the affected area. When erysipelas affects the face, the inflamed area normally includes the nose and both cheeks.

In addition, erysipelas also causes glandular inflammation, which can be extremely uncomfortable as it can be painful for the patient.

Treating erysipelas

Penicillin remains the first choice for the treatment of this disease.

Oral or intramuscular penicillin is sufficient for treating most of the classic cases of erysipelas. Treatment should last for 5 days, but if the infection doesn’t improve, the attending medical specialist can extend it.

First generation cephalosporin can also be an option if the patient has penicillin allergies. Cephalosporins can have a cross-reaction with penicillin and should be carefully administered to patients with histories of serious penicillin allergies.

Clindamycin is a therapeutic option. However, group B streptococcus bacteria are clindamycin-resistant. Treating staphylococcus aureus normally isn’t necessary for most infections. However, it should be considered for the patients that don’t improve on penicillin or for those that have abnormal forms of erysipelas, including bullous erysipelas.

A doctor injecting medication out of a jar.
Penicillin belongs to the family of beta-lactams (β-lactams). Its discovery represented an event of great relevance for medicine.

Other options for treating erysipelas

Some researchers believe that facial erysipelas requires empirical treatment with a penicillinase-resistant antibiotic, such as dicloxacillin or nafcillin, in order to treat possible S. aureus infections. However, there is no evidence that supports this recommendation.

Roxithromycin and pristinamycin are extremely effective for treating erysipelas. Several studies show greater efficiency and fewer side-effects in treatments that use these medications in comparison to those using penicillin.

While the U.S. Food and Drug Administration hasn’t approved these drugs in the United States, they are used in Europe.

The FDA approved 3 antibiotics: oritavancin (Orbactiv), dalbavancin (Dalvance), and tedizolid (Sivextro) for acute bacterial infections and for skin treatments.

These agents are active against Staphylococcus aureus (including strands resistant to methicillin), Streptococcus pyogenes, Streptococcus agalactiae, and Streptococcus anginosus, among others.

Treating erysipelas with surgery

Doctors will only turn to surgery only when the infection has progressed rapidly and killed healthy tissue (necrosis). A surgical operation could then be necessary in order to remove dead tissue.

While most patients can avoid relapses after proper antibiotic therapy, time is of the essence.

Some doctors performing surgery.

Symptom treatment for pains and fever

In addition to antibiotics, other forms of treatment include:

  • Cold packs
  • Hydration (via consumption if possible)
  • Elevation of the affected limb. Raising the area is recommended to reduce inflammation and pain.
  • Saline dressings. Saline dressings should cover the areas showing ulceration and necrosis. In addition, they should be changed every 2 to 12 hours, depending on the severity of the infection.

Diets should include a good amount of fruit (around 20% of your daily dietary intake). In addition, your diet should completely exclude fried foods and meats. Instead, opt for fish and eggs.

Follow this diet for 6 months, allowing for only small breaks in between, and follow your doctor’s instructions.

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  • Lucht F. Which treatment for erysipelas? Antibiotic treatment: drugs and methods of administering. 2001;128(3,2):345-7.
  •  T. Everything you need to know about erysipelas. 2017.
  • Synonyms of Erysipelas. National Organization for Rare Disorders (NORD).
  • Nitto DA, Idiazabal GM, Rodriguez VM y Rossi G.Erisipelas de miembros inferiores. Flebología y Linfología / Lecturas Vasculares 2007(5):221-284