Cellulitis and erysipelas

Question 1

What is cellulitis?

Answer 1

Local infection of the deep dermic and subcutaneous tissue (panniculitis)

Question 2

What is erysipelas?

Answer 2

Superficial skin infection involving the upper dermis

Question 3

How can you differentiate between erysipelas and cellulitis?

Answer 3

Erysipelas:
- sharply demarcated, slightly raised lesion

Cellulitis:
- poorly defined lesion with induration

Question 4

What are the clinical features of cellulitis and erysipelas?

Answer 4

*Have v similar general symptoms

• Localised: Erythema, oedema, warmth, tenderness
• Systemic: fever, chills, confusion, nausea
• lymphangitis
• lymphadenitis
• bullae
• purulent exudate

Question 5

What is the most common cause of cellulitis and erysipelas?

Answer 5

Streptococcus pyogenes

Question 6

What other pathogens (not Strep pyogenes) can cause cellulitis?

Answer 6

• Staph aureus

- Pasteurella multocida - secondary to dog and cat bites

Question 7

What investigations should be done for cellulitis?

Answer 7

Mainly a clinical diagnosis

Can do:

• Soft tissue USS
• Bloods (FBC, ESR/CRP, U&Es etc)
• Skin biopsy, aspirate, and/or blood cultures

Question 8

What is 1st-line management of mild/moderate cellulitis and erysipelas?

Answer 8

Flucloxacillin

2nd line/penicillin allergic: clarithromycin, erythromycin (pregnancy), or doxycycline

Question 9

What is 1st-line of severe cellulitis?

Answer 9

• Co-amoxiclav
• Cefuroxime
• Clindamycin
• Ceftriaxone

Question 10

What are the potential complications of cellulitis?

Answer 10

• Recurrent infections
• Abscess
• Infection of deeper tissues
• Thrombophlebitis, lymphoedema
• Systemic complications: sepsis, endocarditis
• Orbital cellulitis –> blindness, cavernous sinus thrombosis, intracranial abscess