What is your ddx: Superficial cellulitis involving lymphatics. Usually caused by group A beta-hemolytic Streptococcus pyogenes (GAS). Painful, raised sharply demarcated 'orange peel' lesion.

• A. Erysipelas
• B. Abscess
• C. Cellulitis
• D. Impetigo

Answer: (A)

Erysipelas is a superficial cellulitis that involves the upper dermis and lymphatic vessels. The classic picture is a bright red, painful plaque with a clearly defined, raised edge that advances as the infection spreads, producing the sharply demarcated border described. Group A Streptococcus pyogenes is the typical organism. The distinctive edge and superficial lymphatic involvement explain the “orange peel”–like texture and the severe, well‑defined margin. This differentiates erysipelas from cellulitis (which tends to have less distinct borders and deeper tissue involvement), abscess (pus collection with fluctuance), and impetigo (epidermal infection with crusts rather than a dermal-lymphatic, raised plaque).