Cellulitis and Erysipelas
Cellulitis is an acute inflammation of the skin involving the dermis and subcutaneous tissues, caused mainly by
streptococci and staphylococci. Erysipelas has a raised demarcated border, where as the border is not distinct in
cellulitis.
Causes
- Streptococcus and S. Aureus in adults
- Haemophilus influenza type b in children under 3 years
- Cellulitis is sometimes caused by other organisms
Predisposing factors
- Minor trauma
- Pre-existing lesion such as ulcer or erosion
Clinical features
- Erythema (reddening)
- Pain, tenderness
- Acute localised swelling and oedema
- In erysipelas, lesions are more superficial and have a defined raised margin
- Skin becomes tense and shiny in advanced stages
- Regional lymphadentiis may be present
Differential diagnosis
- Lymphoedema
- Acute osteomyelitis
- Deep vein thrombosis (DVT)
- Blunt trauma/fracture
Investigations
- Pus swab for Gram staining and culture and sensitivity
MANAGEMENT
- Elevate the affected limb
- Give an analgesic e.g. paracetamol 1 g every 6-8 hours as required, Child: 10 mg/kg
- Antibiotics: cloxacillin 250-500 mg every 6 hours before food for 7 days
Child: 12.5-25 mg/kg per dose - OR in penicillin allergy, erythromycin 500 mg every 6 hours
Child: 7.5 mg/kg per dose
If severe
- IV ceftriaxone Adult: 1 g every 12 hours for 3 days
Child: 50 mg/kg - Then oral antibiotics to complete 1 week of antibiotics