Integumentary system ORGAN SYSTEMS


Erysipelas (also known as St. Anthony’s fire) is an acute bacterial infection of the dermis and hypodermis that is associated with clinical inflammation.

Acute bacterial infection of the dermis and hypodermis associated with clinical inflammation.

  • Also known as St. Anthony’s fire
  • Specific clinical type of cellulitis studied as a specific entity


Streptococcus pyogenes (β-hemolytic group A streptococci)

Primary organism responsible
  • Minor trauma, insect bites, dog bites, eczema, athlete’s foot, surgical incisions and ulcers 
  • Athlete’s foot (M/C portal of entry)

Clinical features

Well-demarcated erythematous skin lesion with raised edges:

After a sudden onset, areas of erythema and edema characteristically enlarge with well-defined margins.
  • Sites: Leg (M/C) > Face, arm, and upper thigh

Associated features:

  • High fever
  • Adenopathy and lymphangitis

Milian’s ear sign:

The pinna has no deeper dermis and subcutaneous tissue so redness there cannot be cellulitis.
Ear involvement is called Milian’s ear sign, and it is a feature distinguishing erysipelas from cellulitis, because the pinna has no deeper dermis and subcutaneous tissue and erysipelas, being a cutaneous condition can spread to it | Suzuki, K. and Otsuka, H. (2017). Bilateral Milian’s Ear Sign of Erysipelas. Internal Medicine, 56(17), pp.2381-2382.

Differential diagnosis:

All of which present with erythema, warmth, edema, and pain
  • Cellulitis: Erysipelas is more superficial than cellulitis and is typically more raised and demarcated
  • Others: Abscess, felon, gout, and paronychia
Pediatric Skin and Soft Tissue Infections | Approach to the Pediatric Patient with a Rash | Clinical Gate. Retrieved February 05, 2021, from


Penicillin monotherapy:

First-line antibiotic used for the treatment of erysipelas

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