ERYSIPELAS AND CELLULITIS
Cellulitis is a common bacterial infection of the dermal and subcutaneous tissue. Erysipelas is best regarded as a more superficial form of cellulitis. The causative streptococci usually gain their entry through a split in the skin, e.g. between the toes or under an ear lobe. If treated promptly the infection is usually confined to the affected area, however, more severe episodes can lead to septicemia.
Etiology:
- Streptococcal infection, especially group A (Streptococcus pyogenes), is the most common cause of cellulitis and erysipelas.
- Staphylococcus aureus can occasionally cause cellulitis
- Unilateral childhood facial cellulitis can be due to Haemophilus influenza type b and orbital cellulitis is often caused by Streptococcus.
Clinical findings - Although any site can be affected, the legs followed by the face are the most common sites. Facial involvement tends to be more superficial i.e. erysipelas. The rash is normally unilateral, except on the face where it is occasionally bilateral.
- Erythema - the edge is more well-demarcated in erysipelas than in cellulitis
- Edema is common
- Hot and tender to touch
- The presence of haemorrhage, bullae, or lymphangitis suggest streptococcal infection as opposed to staphylococcal infection
- Severe cellulitis can lead to ulceration and more deep-seated tissue damage
Treatment:
- elevation
- rest-sometimes in hospital
- systemic antibiotics, sometimes given intravenously.
- Low dosage long-term oral penicillin V will usually cut down the frequency of recurrences.