Erysipelas: What This Painful, Shiny Red Rash Is, How It's Treated, and Why Prompt Antibiotics Matter

Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: November 2026

Quick Answer

Erysipelas is a bacterial skin infection, a type of cellulitis, that affects the upper skin layer and nearby lymph vessels, causing a raised, shiny, painful rash, often with fever and chills [4]. It typically appears on the legs or face and is usually caused by Group A strep [4]. Most people recover fully with antibiotics, but untreated cases can become life-threatening [4].

What the research says

• Low-dose penicillin can prevent repeat leg infections while it is being taken. In a double-blind trial of 274 patients with two or more episodes of leg cellulitis, 22% (30 of 136) taking penicillin had a recurrence during the 12-month prophylaxis phase versus 37% (51 of 138) on placebo (hazard ratio 0.55; number needed to treat 5), but the protection faded after the drug was stopped — a first recurrence occurred in 27% of both groups in the follow-up period (PubMed: Thomas et al., N Engl J Med, 2013 [1]).

• Pooled evidence agrees, but the effect does not last. A Cochrane systematic review of six trials (573 evaluable participants) found that antibiotic prophylaxis decreased the risk of recurrent erysipelas and cellulitis by 69% while on treatment compared with no treatment or placebo (risk ratio 0.31; moderate-certainty evidence), but the protective effect did not last after prophylaxis was stopped (risk ratio 0.88; low-certainty evidence); the findings apply mainly to people with at least two episodes of leg cellulitis (PubMed: Dalal et al., Cochrane Database Syst Rev, 2017 [2]).

• After a first episode, the benefit is less certain. In the PATCH II trial of 123 participants (31% of the target because of slow recruitment), 79% of whom had had one previous episode, 20% (12 of 60) taking penicillin V had a repeat episode versus 33% (21 of 63) on placebo (hazard ratio 0.53), but the difference did not reach statistical significance (P=0.08) (PubMed: Thomas et al., Br J Dermatol, 2012 [3]).

What Is Erysipelas?

Erysipelas (pronounced "eh-ruh-SI-puh-luhs") is a bacterial skin infection. It affects the top part of a deeper skin layer and the nearby lymph vessels. It causes a raised, discolored, shiny, and painful rash [4]. The rash usually affects only one side of the body, which doctors call unilateral [4]. It most commonly affects the lower extremities — the hips, thighs, knees, ankles, and feet [4].

Providers sometimes call it "Saint Anthony's fire." That dramatic old name is a warning: this infection can get serious if it is not treated right away [4].

Erysipelas is a type of cellulitis. Cellulitis is a group of skin infections that target the skin and the tissue underneath it [4].

Question	Answer
What is it?	A bacterial skin infection of the upper skin layer and nearby lymph vessels [4]
Also called	St. Anthony's fire; a type of cellulitis [4]
Who gets it?	Anyone — more often in children and adults ages 60–80 [4]
Where does it appear?	Most commonly legs, thighs, hips, ankles, feet; also face, arms, ears, belly [4]
Which side?	Usually one side of the body (unilateral) [4]
What causes it?	Mostly Group A strep bacteria entering through broken skin [4]
Is it contagious?	No — the rash isn't, but the bacteria can spread person to person [4] [5]
Does it need treatment?	Yes — prompt antibiotics to avoid serious complications [4]

Symptoms: What Does an Erysipelas Rash Look Like?

Erysipelas does not just cause a rash. Whole-body symptoms often show up as the infection takes hold [4].

Symptom	How it shows up
Fever	Elevated temperature as the body fights the bacteria [4]
Chills	Sudden shivering or cold feelings [4]
Headache	Head pain accompanying the infection [4]
Joint pain	Aching in the joints [4]

Figure 1: At a glance — what erysipelas is and who gets it.

The rash itself has a distinctive set of features. If a rash matches several of these at once, that pattern is worth showing a provider.

What you see or feel	Description
Bumpy with fluid-filled blisters	The surface may be bumpy, sometimes with blisters [4]
Red to purple (or darker on deeper skin tones)	Discoloration that may differ from your natural skin tone [4]
Shiny	The skin takes on a glossy appearance [4]
Swollen	Raised and bigger than the skin around it [4]
Tender or painful	The area hurts to the touch [4]
Warm	The skin feels hot compared to surrounding areas [4]

Figure 2: What to look for — rash features and whole-body symptoms.

Where Do Symptoms Form?

Symptoms target the part of the skin you can see and touch — the epidermis [4]. The infection can also reach deeper layers called subcutaneous tissue, which you cannot see [4].

Body area	Notes
Legs	Most common site, along with thighs, knees, ankles, and feet [4]
Face	Second most common site
Arms	Less common
Ears	Less common
Belly	Especially near the belly button in infants [4]
Areas with lymph nodes	Like the armpits or groin
Prior surgery or injury sites	Bacteria enter through broken skin [4]

Causes: How Does an Erysipelas Infection Start?

An infection causes erysipelas. Group A streptococci bacteria are the most common culprit [4]. The bacteria enter the body through broken skin — usually an open wound [4]. Bacteria can also enter through an insect bite, a surgical cut, or an open sore [4].

Is Erysipelas Contagious?

Erysipelas itself is not contagious [4]. But the bacteria that cause it can spread from person to person [4] [5]. To avoid spreading germs, stay home until your symptoms go away [4]. This helps protect others.

Risk Factors: Who Is More Likely to Get Erysipelas?

Erysipelas can affect anyone, but some people have a higher risk. It happens more often in children and adults between ages 60 and 80 [4].

Risk factor	Why it matters
Blocked lymph vessels [4]	Slows the immune system's ability to fight skin infections
Lymphatic edema (fluid-buildup swelling) [4]	Same drainage problem
Nephrotic syndrome (a kidney condition) [4]	Raises infection risk
Obesity, diabetes, or liver disease [4]	Each independently raises risk
Skin conditions (eczema, athlete's foot) [4]	Weaken the skin barrier bacteria pass through
Substance use disorder [4]	Raises risk
Weakened immune system [4]	Less defense against bacteria
Dialysis access (such as an AV fistula) [4]	Creates skin entry points
Recent major surgery [4]	Creates skin entry points

Complications: What Problems Can an Erysipelas Infection Cause?

Erysipelas can become serious if you do not treat it right away. The infection can spread through the blood and cause bacteremia or sepsis [4]. These can be life-threatening [4].

Complication	What it involves
Bacteremia	Bacteria in the bloodstream [4]
Sepsis	Body-wide, life-threatening response to infection [4]
Hemorrhagic purpura [4]	Bleeding under the skin
Meningitis [4]	Brain infection
Thrombophlebitis [4]	Inflamed veins
Pneumonia [4]	Lung infection
Skin abscesses [4]	Pockets of pus in the skin
Scarlet fever [4] [5]	Rash illness from the same bacteria
Elephantiasis [4]	Severe, long-lasting swelling
Necrosis [4]	Skin death

Even with treatment, complications are still possible [4]. You may also get erysipelas symptoms again. Repeat infections may cause scarring and long-term skin damage [4].

Diagnosis: How Is Erysipelas Diagnosed?

Doctors diagnose erysipelas by looking at your skin and asking about your symptoms [4]. They often ask if you had a recent cut, bug bite, or skin problem, since these can let bacteria into the body [4].

Your provider probably will not need lab tests to confirm a diagnosis [4]. But tests can help figure out which bacteria is causing the infection. They might do a blood test or a culture test to get this information [4].

Step	What happens
Skin exam	Provider looks at the raised, shiny, discolored rash [4]
Symptom history	Asks about fever, chills, pain, and when it started
Exposure history	Asks about recent cuts, bug bites, or skin problems [4]
Blood test (if needed)	Helps identify the bacteria [4]
Culture test (if needed)	Confirms which bacteria is causing the infection [4]

Treatment: How Is Erysipelas Treated?

Providers treat erysipelas with antibiotics — medications that destroy bacteria [4]. Most people take oral antibiotics at home for about five to ten days [4]. If the infection is more serious, a provider may give antibiotics through an IV in a hospital or clinic [4].

Treatment	How it works
Oral antibiotics (home, 5–10 days)	The default for most cases [4]
IV antibiotics	For more serious infections, given in a hospital or clinic [4]
Penicillin	The most common medicine [4]
Erythromycin or cephalexin	Alternatives if you cannot take penicillin [4]
Long-term antibiotics	Daily oral doses or a penicillin shot every few weeks, for people who get infections often [1] [2] [4]

Supporting Care at Home

Other helpful treatments include drinking plenty of fluids, raising the infected area to reduce swelling, taking acetaminophen for fever or aches, and using cold compresses to ease pain [4].

Figure 3: How erysipelas is diagnosed and treated, and what recovery looks like.

What Is the Recovery Time?

You should start to feel better soon after you take antibiotics [4]. The infection clears up first, but your skin may take a few weeks to fully heal [4]. While your skin heals, avoid scratching, rubbing, or injuring the area [4]. This prevents more damage and lets your skin recover faster.

Outlook: What Can I Expect If I Have Erysipelas?

Erysipelas sounds scary, but with treatment, most people recover well [4]. You should start to feel better in a few days [4].

Question	Answer
When do I feel better?	In a few days of starting antibiotics [4]
How long until the skin heals?	A few weeks
Is peeling skin normal?	Yes — peeling as the skin heals is normal and not a warning sign [4]
Will there be lasting damage?	Most people recover without lasting damage or scarring [4]
Can it come back?	Yes — if another skin injury or infection occurs [4]

The rash might show up on your face or other visible areas. This may make you feel embarrassed or self-conscious until the rash heals [4], which could take a few weeks. Your skin might peel as it heals — this is normal and does not mean something is wrong [4].

Is There a Cure for Erysipelas?

Yes. Antibiotics cure erysipelas [4]. They work by killing the bacteria that cause the infection [4].

You need to take all of your antibiotics exactly as your doctor tells you. If you skip doses or stop early, the infection might not go away completely [4]. This can also make it more likely to come back [4]. Even after treatment, erysipelas can return if you get another skin injury or infection [4]. Let your provider know if you have had erysipelas before, so they can help lower your risk of it happening again [4].

Prevention: Can Erysipelas Be Prevented?

You cannot prevent all cases, but you can take steps to protect yourself.

Prevention step	What it does
Avoid cuts and scrapes [4]	Removes the main entry point for bacteria
Clean sores and wounds right away [4]	Stops bacteria before they spread
Stay away from people who have an infection [4]	Reduces exposure to the bacteria
Wear protective gear during sports or activities [4]	Prevents injury-related breaks in the skin
Wash hands often with soap and water [4]	Removes bacteria from the hands

When Should You Call a Healthcare Provider?

Call your provider right away if you notice signs of erysipelas — pain, fever, chills, or a swollen rash [4]. Erysipelas can be dangerous if you do not treat it [4], so do not wait to get help.

Warning sign	Why it matters
Raised, shiny, swollen rash	The hallmark sign of the infection
Rash with pain and warmth	Active infection needing antibiotics
Fever and chills with a rash	Sign the infection is affecting the whole body
Rash spreading or worsening	Possible progression toward serious complications

Conclusion: Do Not Wait on This Rash

Erysipelas sounds scary, and its old name — St. Anthony's fire — is a reminder not to take it lightly. It is a bacterial skin infection that produces a raised, swollen, shiny, painful rash, most often on the legs or face. The good news is that antibiotics cure it, and most people start feeling better within a few days, with the skin healing fully over a few weeks [4]. The important part is timing: untreated erysipelas can spread into the blood and become life-threatening [4]. If you have a painful, swollen, shiny rash with fever or chills, call a healthcare provider today. If you have had erysipelas before, mention it at your visit — that history helps your provider protect you from repeat infections.

Take the Next Step

Protect your skin and act fast. Clean every cut, scrape, and insect bite right away, wash your hands often, and do not sit on a painful, swollen, shiny rash with a fever. If you or your child develop these signs, contact a healthcare provider the same day. And if you struggle with recurring skin infections, talk to a provider about long-term prevention options such as daily antibiotics or periodic penicillin injections.

Related on Rinnit: Cellulitis: Symptoms, Causes, Diagnosis and Treatment — What You Need to Know · Sepsis: Complete Guide to Symptoms, Causes, Risks, and Treatment

Further reading: CDC — About Group A Strep Infection · Cleveland Clinic — Erysipelas

Frequently Asked Questions

1. What is erysipelas?

Erysipelas is a bacterial skin infection — a type of cellulitis — that causes a raised, discolored, shiny, painful rash with fever and chills, usually on the legs or face. Group A strep bacteria are the usual cause, and prompt antibiotics cure most cases.

2. What does erysipelas look like?

Erysipelas looks like a raised, swollen rash that is red to purple on lighter skin or darker than your natural skin tone on deeper skin. It is shiny, warm to the touch, tender, and sometimes bumpy with fluid-filled blisters.

3. What causes erysipelas?

Group A streptococci bacteria cause most cases. The bacteria enter through broken skin — usually an open wound, but also an insect bite, a surgical cut, or an open sore.

4. Is erysipelas contagious?

Erysipelas itself is not contagious. However, the bacteria that cause it can spread from person to person, so staying home until symptoms go away helps protect others.

5. Who gets erysipelas most often?

Erysipelas can affect anyone, but it happens more often in children and in adults between ages 60 and 80.

6. What are the risk factors for erysipelas?

Higher risk comes from blocked lymph vessels, lymphatic edema, nephrotic syndrome, obesity, diabetes, liver disease, eczema, athlete's foot, substance use disorder, a weakened immune system, dialysis access, and recent major surgery.

7. How is erysipelas diagnosed?

Doctors diagnose it by examining the skin and asking about symptoms and recent cuts or bites. Lab tests are usually not needed, but a blood test or culture test can identify the specific bacteria.

8. How is erysipelas treated?

With antibiotics — most commonly penicillin — taken by mouth at home for about five to ten days. Serious cases may need IV antibiotics. Erythromycin or cephalexin are alternatives if you cannot take penicillin.

9. How long does erysipelas take to heal?

Most people start feeling better within a few days of starting antibiotics. The infection clears first, and the skin typically takes a few weeks to fully heal. Skin peeling during healing is normal.

10. Can erysipelas come back after treatment?

Yes, it can return if you get another skin injury or infection. Tell your provider about any past erysipelas so they can help lower your risk, including long-term antibiotic options.

11. What is the difference between erysipelas and impetigo?

Both are bacterial skin infections. Erysipelas causes a discolored, shiny, swollen rash, usually on the face or legs. Impetigo causes an itchy, painful rash with blisters, often around the mouth and nose.

References

1. Thomas KS, Crook AM, Nunn AJ, et al. Penicillin to prevent recurrent leg cellulitis. N Engl J Med. 2013;368(18):1695-1703. doi:10.1056/NEJMoa1206300. PMID: 23635049.

2. Dalal A, Eskin-Schwartz M, Mimouni D, et al. Interventions for the prevention of recurrent erysipelas and cellulitis. Cochrane Database Syst Rev. 2017;6(6):CD009758. doi:10.1002/14651858.CD009758.pub2. PMID: 28631307.

3. Thomas K, Crook A, Foster K, et al. Prophylactic antibiotics for the prevention of cellulitis (erysipelas) of the leg: results of the UK Dermatology Clinical Trials Network's PATCH II trial. Br J Dermatol. 2012;166(1):169-178. doi:10.1111/j.1365-2133.2011.10586.x. PMID: 21910701.

4. Cleveland Clinic. Erysipelas. Cleveland Clinic Health Library. Medically reviewed; last updated July 2, 2026. https://my.clevelandclinic.org/health/diseases/erysipelas

5. Centers for Disease Control and Prevention. About group A strep infection. CDC. Last updated July 31, 2025. https://www.cdc.gov/group-a-strep/about/index.html

Medical Disclaimer

This article is for informational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read here.