Erysipelas is a dermatological disorder caused by bacterial infection. The infection usually involves the epidermal layers of the face or leg and manifests as a well-defined, elevated, painful and erythematous skin lesion. Causative bacteria are mainly members of the Streptococcus family. Antibiotic treatment and in severe cases surgical debridement are required for a recovery. The probability of erysipelas recurrence is up to twenty percent.
Erysipelas occurs when bacteria invade the epidermis as a consequence of skin lesions. Patients with eczema or patients who engage in strong physical activities as well as patients with a weakened or systemically impaired immune system are at an increased risk of developing erysipelas. Children younger than six and seniors older than sixty are mostly affected by erysipelas. Furthermore, patients with a history of drug use also face an increased erysipelas risk because of regular injections. Possible other causes for erysipelas include skin ulcers, surgical incisions, insect bites, psoriasis, and edema feet secondary to cardiac insufficiency and diabetes  .
Erysipelas has been shown to be caused by an infection with the following bacteria: group A / C / D streptococci, Klebsiella pneumonia, Haemophilus influenza, Escherichia coli, and Moraxella. Notably, methicillin-resistant Staphylococcus aureus has also been found in the context of erysipelas  .
Typical symptoms of erysipelas are a large, elevated, painful erythematous skin patch with sharp borders, blisters, swollen glands, fever, chills and general malaise. Most facial infections are attributed to group A streptococci and usually affect both cheeks and the nose. Erysipelas can also occur after a throat infection with subsequent bacterial migration to the nasal passages .
The most common complications of erysipelas include abscess, gangrene, and thrombophlebitis. In selected cases, acute glomerulonephritis, endocarditis, septicemia, and streptococcal toxic shock syndrome may occur. Osteoarticular complications may present as bursitis, osteitis, arthritis, and tendinitis  .
Classical erysipelas usually does not require elaborate diagnostic workup. However, it is important to distinguish erysipelas from a symptomatically similar type of cellulitis, which does not present with sharp borders with inflammation.
Erysipelas diagnosis is based on a clinical examination of the affected area and an analysis of the patient history. In selected cases, routine blood analysis may be ordered, which commonly reveals an increased erythrocyte sedimentation rate and C-reactive proteins. Standard imaging techniques are usually not necessary for the diagnosis  .
Bacterial cultures extracted from the infected tissue rarely yield satisfying results. Histological characteristics are dermal edema, vascular dilatation and streptococcal invasion of lymphatics and tissues resulting in an increased presence of neutrophils and mononuclear cells. Bacteria may also infiltrate proximal blood vessels .
Surgical removal of erysipelas may be necessary if the infection has led to tissue necrosis. Recurrent erysipelas may occur in around 20% of the patients  with potentially disabling disfigurements (e.g. elephantiasis nostras verrucosa).