Erysipelas and Cellulite - Symptoms, Causes and Treatment

Erysipelas and cellulitis are two infections with similar characteristics that develop when bacteria can overcome the skin barrier, invading and infecting the subcutaneous tissues.

The term cellulite causes some confusion by designating two different diseases. Those irregularities in the skin by accumulation of liquid and fat, which both plague women, popularly known as cellulite, is actually called in gynecological hydrolipodystrophy medicine. We have a specific text about this type of cellulite.


Skin infections

The skin is our main organ of defense. It is she who keeps our inner environment isolated and prevents germs from the external environment invade our body.

Any object or being of nature is filled with bacteria, viruses, fungi and other germs on its surface. If we did not have skin, our organs would come in direct contact with these germs and we would have one infection after another. We would die of sepsis soon after birth and we would be extinct thousands of years ago. It is no wonder that all living beings have some kind of tissue that plays the role of the skin.

If on the one hand the interior of the body is isolated from the germs, on the other our skin is full of these. Any material, whether organic or not, when exposed to the environment, acquires its load of microbes.

When we open a wound in the skin, even if very small, a break occurs in this protective barrier, exposing our interior to the germs of the external environment. The most common infections are those that occur by bacteria that live naturally on our skin and take advantage of any injury to invade our subcutaneous tissues.

Erysipelas and cellulitis are two infections of bacterial origin that affect the inner layers of the skin, taking advantage of some lesion of the same that serves as a gateway.

Therefore, erysipelas and cellulitis are infections of the inner layers of the skin. If not treated properly, these invasive bacteria can migrate to other regions of the body such as the bloodstream and internal organs.

Differences between erysipelas and cellulitis

Notice the figure below that represents the layers of our skin. The major difference between erysipelas and cellulitis is where the bacteria lodge and causes infection. In erysipelas the infection occurs in the layers closest to the exterior, affecting the epidermis and the superficial layer of the dermis. Cellulitis is a deeper infection, infecting the fatty tissue in the hypodermis and the deep layer of the dermis.


Both lesions are very similar and often difficult to distinguish. Both erysipelas and cellulitis appear clinically as a skin infection, with flushing (redness), local heat, intense pain and swelling (edema) at the affected site.

Because erysipelas is a more superficial infection than cellulitis, some features help in differential diagnosis. In erysipelas, the lesion usually presents a slight relief and its edges are very clear. When examining the skin it is easy to know where the infection begins and ends. The delimitation between diseased skin and healthy skin is clear.

Cellulite, because it affects deeper tissues, does not present these clear limits. The lesion is usually more diffuse and it is not always possible to know exactly where the infection begins and ends. The photo below shows a clear example of the difference between cellulite and erysipelas.

In erysipelas, systemic symptoms such as fever, sweating and chills usually appear early, as soon as the first signs of skin infection appear. In cellulitis the picture is usually more drawn, first appearing the lesion, and only after a few days does the fever appear. Other symptoms of the infection may be loss of appetite, nausea, vomiting, malaise, inappetence and headaches.

Erysipelas usually occurs more in children and the elderly, since cellulitis is more common in adults over 50 years.

The lower limbs are the most affected sites in both erysipelas and cellulitis. However, any area of the skin may be affected.

Curiosity: The ear is a site that does not have subcutaneous tissues, therefore, an infection in this region can only be erysipelas.

In severe cases, the infection becomes more diffuse and the distinction between the two diseases is more difficult. Some signs of severity include the formation of blisters, ulcers, and skin necrosis. Severe cases, with deep infections, can progress to osteomyelitis, which is the infection of the bone. Another complication is endocarditis , infection of the heart valves by bacteria that migrate through the bloodstream.

If left untreated, cellulitis and erysipelas can progress to sepsis with high risk of death for the patient.

Erysipelas usually affects the superficial lymphatic vessels of the skin and may cause lymphatic edema. When this infection occurs chronically, the destruction of these vessels can lead to chronic edema similar to that occurring in elephantiasis (filariasis). It is a very common injury in homeless people, especially in the elderly. Lymphatic edema is a typical complication of repetitive erysipelas, but may also occur in cellulitis.

Risk factors

As has been said at the beginning of this text, any lesion that serves as a gateway to bacteria becomes a risk factor for the development of skin infections. Among the most common are:
  • Simple cuts and wounds
  • Athlete's foot
  • Eczemas
  • Impetigo
  • Varicella (chicken pox) or other rashes on the skin
  • Pimples (acne)
  • Mosquito bites
  • Ingrown nail or any other nail injury
  • Mycosis fungoides
  • Intravenous drug use
  • Burns
  • Animal bites
  • Implantation of piercings

In addition to skin lesions, there are other factors associated with an increased risk of erysipelas and cellulites:


Two bacteria that live on our skin are responsible for more than 80% of cases of cellulitis and erysipelas. These are Streptococcus and Staphylococcus. The Staphylococcus MRSA, a multi-resistant form of the bacteria, can also cause skin infections. The erysipelas are usually caused by Streptococcus, while cellulite by Staphylococcus . This, however, is not a rule. Several other bacteria may be responsible for the disease, including Haemophilus influenzae, Yersinia enterocolitica, Streptococcus pneumoniae, Klebsiella pneumoniae, Pasteurella multocida, Pseudomonas aeruginosa and Clostridium.


Because they are a bacterial infection, treatment for these two infections should be done with antibiotics. The initial schedule should include a drug that has action on Streptococcus and Staphylococcus.

The choice between antibiotics orally or intravenously should be made according to the severity of the case. Injuries to the face, severe lesions or in patients with immunosuppression should preferably be treated with intravenous drugs.

The treatment time is usually 14 days.

The main choices are penicillins and their derivatives. Some options include cephalexin, flucloxacillin, dicloxacillin, amoxicillin, oxacillin, and cephalothin. Allergic to penicillin can be treated with erythromycin or clindamycin.

In suspected cases of Staphylococcus MRSA (resistant Staphylococcus), treatment should be done with vancomycin via the venous route.

The correct antibiotic is a choice of your doctor and the schedule may vary from region to region according to the resistance profile of the bacteria.

In addition to antibiotics, resting and elevating the affected limb are important because they help decrease edema and relieve pain.

In cases of recurrent erysipelas where the risk factors can not be controlled, prophylactic treatment with a dose of benzathine penicillin (benzetacil) may be indicated every month for several months.

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