Erysipelas (bullosa): what is it, causes, treatments, is it curable?


What is erysipelas?

Erysipelas is an infectious disease caused by the bacterium Streptococcus pyogenes . It is characterized by red, inflamed and painful wounds on the skin, especially on the lower limbs, such as legs and feet.

The name may not be very common, but erysipelas is yet another member of the group of existing infectious dermatoses and can also be served, popularly, by zipra , esipra , zipla , maldapraia , among other names.

The disease does not have an exact frequency to appear in the body, being able to appear only once or several times during the whole year, or even to last throughout life.

If not treated properly, the erysipelas can progress, becoming a bullous erysipelas , causing blisters that are about 10cm long and that contain a liquid that can be transparent, yellow or brown.

In the vast majority of cases, erysipelas is not contagious. However, it is possible for one person to pass the disease on to another in cases where he or she developed bullous erysipelas.

Although low, this possibility exists because, in its bullous form, erysipelas can cause the patient to present secretions. If the bacterium that causes erysipelas is present in these secretions, there is a possibility that transmission may occur.

In addition, people who live with patients who developed erysipelas must take special care, as explained by Dr. Clívia Carneiro, a dermatologist at the Brazilian Society of Dermatology (SBD).

“People who live with patients with erysipelas should be extremely careful with hygiene, especially immunosuppressed people, avoiding manipulating the affected area, always washing their hands and should not share items used by the patient, such as clothes, towels, soap, etc.”

This is not only because of the erysipelas itself, but because the bacterium Streptococcus pyogenes is also responsible for numerous other diseases, such as pharyngitis and necrotizing fasciitis.

The progression of the disease can be worrisome, especially when repeated outbreaks of the disease occur. When this happens, the erysipelas can evolve into elephantiasis.

Because their symptoms are very similar to those of another skin infection called cellulite (which is not that irregularity in the skin that bothers women so much), many people confuse one disease with another.

However, it is worth knowing that they are not the same, since erysipelas reaches the outermost layers of the dermis and cellulite reaches the deepest layers, including fatty tissue, located in the hypodermis.

The disease can be found in the International Disease Code (ICD-10) through code A46.

But, what causes erysipelas?

Most of the time, the disease is caused by the bacterium Streptococcus pyogenes , group A, but it can also be caused by the bacterium Haemophilus influenzae type B.

These bacteria penetrate our skin through small wounds that we may have, such as chilblains, ingrown hairs or nails, and spread through our lymphatic vessels.

It is practically impossible to prevent these bacteria, as they can be present anywhere, including our skin. Other causes that can trigger an erysipelas are:

  • Ulcers on the skin;
  • Surgical incisions;
  • Insect bites;
  • Some skin diseases, such as psoriasis;
  • Application of illegal drugs, such as heroin;
  • Swollen legs due to a health problem, such as diabetes.

The disease develops, in most cases, in the lower limbs, such as legs and feet (75% of the time), but there are also cases of development in the face, which is directly linked to seborrheic dermatitis .

Erysipelas or cellulite?

Both erysipelas and cellulite are caused by bacteria that infect the skin. What will differentiate one case from another is the depth of the infection. To understand this, however, it is necessary to remember beforehand what the skin’s anatomy looks like.

Our skin is divided into layers. Superiorly, we have the epidermis, which we can see and touch directly. Below it, we have the dermis, the deepest layer of the skin, where the hair and hair follicles are born. Then there is a layer of fat that separates the skin from the muscles.

Erysipelas happens when the infection caused by the bacteria reaches the dermis. When the infection reaches the fat below the dermis, we have cellulite.

However, it is important to note that the cellulite we are talking about here is not the skin with a wavy aspect, which receives the technical name of gynoid lipodystrophy, but rather an infection of the subcutaneous cellular tissue, that is, of the fat layer below the skin. skin.

Is erysipelas contagious?

” The bullous form of erysipelas has a risk of being contagious ” explains Dr. Carlos Augusto Zanardini Pereira, dermatologist and professor at PUC-PR. “For this, it is necessary for the patient to present secretions. When there is secretion, there may be the presence of the bacteria, which increases the chances of possible transmission. ”

For transmission of erysipelas to occur, however, it is necessary for the healthy person to have some opening in the skin, such as a scratch or a badly healed mosquito bite, that is, the healthy person must have wounds on the body and come into contact with secretions. of the patient with bullous erysipelas.

The chances of something like this happening are considerably low, however, they do exist. Especially immunosuppressed patients should take this information into account, as the same bacteria that causes erysipelas is also the cause of other diseases, such as:

  • Pharyngitis;
  • Scarlet fever;
  • Fasciite necrosante;
  • Cellulitis;
  • Impetigo (superficial skin infection);
  • Toxic shock syndrome (a rare medical emergency caused by a bacterial toxin).

For this reason, it is of the utmost importance that people living with a carrier of erysipelas take all necessary precautions not to come into contact with the bacteria. That is, washing your hands and not sharing personal items is the least you can do.

What are the groups most at risk for contracting the disease?

The people most likely to contract erysipelas are:

  • Children aged 2 to 6 years;
  • Adults over 60;
  • Overweight people;
  • Uncompensated diabetes patients;
  • People who have a decrease in the number of lymph nodes, such as those with lymphedema or recently out of mastectomy;
  • People with venous insufficiency in the lower limbs;
  • People with heart disease and kidney disease with swelling in their legs;
  • People who are immunosuppressed or have debilitating chronic illnesses.

If someone you know is in this risk group and has symptoms of the disease, suggest that they go to a doctor. Oh, and don’t worry about yourself, either, if you stay in direct contact with that person, as the disease is not contagious.


In addition to the reddish wounds we mentioned at the beginning of the text, other main symptoms of the disease are:

  • Small blisters on the skin;
  • Fever;
  • Nausea and vomiting;
  • Chills.

Bullous erysipelas

In the case of bullous erysipelas, the bubbles are about 10 cm long and contain a liquid that can be transparent, yellow or brown. In addition, if the wound is on the legs or feet, water (a lump that gets under the skin and hurts when it is touched) in the groin may appear and the local temperature may rise.


The diagnosis of the disease is always made by a general practitioner or a dermatologist , who, as well as for other dermatoses, will know how to correctly indicate the type of treatment for your case.

Normally, because there is no need, the specialist does not ask for any exam other than the clinician who does it himself. However, there are some who request a blood test, or even a skin biopsy, to confirm what type of bacteria is causing the disease.

Does Erysipelas have a cure?

When diagnosed quickly, erysipelas is curable . It occurs through drug treatment with antibiotics and measures to prevent its reappearance.


The main form of treatment for erysipelas is through the use of antibiotics from the penicillin family, however, patients allergic to this substance also have a medication option.

It lasts around 10 to 14 days and is done orally, in the simplest cases. When the patient has a more severe condition, the use of intravenous antibiotics may be necessary.

Basically, the treatment will vary from case to case. Through the culture of the collected bacteria, it is possible to know which one is causing the disease and choose an antibiotic that has the greatest effect.

In addition to drug treatment, the patient may also be instructed to take some care at home. Check out which ones are below.

Home treatment

When you see the disease, you should:

  • Rest most of the day with the infection site in a higher position than your body;
  • Take a few walks around the house with your rest;
  • Drink plenty of fluids;
  • Make cold water compresses over the wounds.

However, it is important to note that home treatment alone does not solve the problem . Erysipelas is an infection of the subcutaneous tissue that, if left untreated, can lead to widespread infection if there is no prompt medical attention.


Surgeries for the treatment of erysipelas are only necessary in extreme cases of the disease, that is, when it develops in the body in a very fast way and kills several healthy tissues of the body, causing necrosis, gangrene or abscesses. The surgery procedure, in these cases, seeks to remove the affected tissue.


The drugs prescribed by your dermatologist are usually for a week or so. Among them are:

  • Penicillin (the most used in cases of erysipelas);
  • Ampicillin ;
  • Cephalexin ;
  • Amoxicillin ;
  • Cefradina;
  • Ciprofloxacin .

For those who are allergic to penicillin, the drugs commonly used are:

  • Erythromycin ;
  • Clarithromycin ;
  • Clindamicina.

In the case of bullous erysipelas, the most serious case of the disease, medications can be applied through veins, in a hospital, or through antimicrobial creams, such as 2% fusidic acid and 1% argic sulfadiazine .


NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.

Living together

Patients who have recurrent cases of erysipelas are people who will normally have to live with the disease. Therefore, they must take some measures to increase the quality of life, such as:

  • Wear compression stockings;
  • Moisturize the skin;
  • Do physical exercises;
  • Elevate the affected limb when sleeping;
  • Adopt a healthy diet;
  • Practice alcohol abstinence;
  • Control the weight;
  • If prescribed by a doctor, use prophylactic antibiotic therapy.


In most cases, the prognosis of erysipelas is positive, that is, if the patient follows the treatment correctly, it will most likely not develop the condition again and will not have major complications.

However, while some patients may have recurrent illnesses, others, with compromised immune systems, may have major complications, developing conditions ranging from abscesses to generalized infection.

If the treatment is not done, are there any complications?

In some patients, the infection of erysipelas can be repeated several times, which results in changes in circulation and an increased predisposition to chronic swelling in the affected area.

Weakened patients are more likely to develop more severe conditions, in which the infection can become generalized and lead to death.

It should be noted that complications can happen and that, in these cases, only rapid treatment can prevent further damage. A more serious infection usually presents as symptoms:

  • Strong pains;
  • Fever;
  • Cold sweat;
  • Skin pallor;
  • Sickness;
  • Increased respiratory rate;
  • Drowsiness, confusion and problems with consciousness.

If you notice these symptoms, call the emergency service immediately.

In addition, if left untreated, the disease can cause complications such as:

  • Abscesses;
  • Emergence of blood clots;
  • Gangrene (tissue death);
  • Blood poisoning, which happens when the infection passes the bloodstream;
  • Infection of blood valves;
  • Joint and bone infections;
  • If the infection is present close to the eyes, it is likely to reach the brain.

How can I prevent Erysipelas?

As much as the disease cannot always be prevented, you can follow some tips to avoid it:

  • As with any infection, wash your hands constantly to prevent the bacteria from proliferating;
  • Always keep wounds clean;
  • Do not walk barefoot and change your socks every day, giving preference to cotton ones;
  • If you have athlete’s foot, treat it;
  • Use moisturizers to prevent your skin from becoming dry;
  • Try not to scratch your skin too often;
  • If you have another skin condition, such as psoriasis and eczema, keep your treatment up to date.

As much as erysipelas is not common knowledge to people, it can cause several complications if not treated as soon as possible, like any disease. That is why this information about the disease, including causes, symptoms and treatments, is so important when it is passed on.

Do your part and, any questions you still have about erysipelas, ask here in the comments that we answer!