Erysipelas and Cellulitis

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Erysipelas is an acute superficial spreading infection commonly caused by Streptococci without pus formation. Could also be due to Gram negative bacilli. 

Clinical presentation 

A prodrome of fever, chills, and malaise 

  • Locally, a large erythematous, swelling, well-demarcated, and usually raised lesion
  • Regional adenopathy is frequent
  • Superficial blistering secondary to edema
  • Superficial hemorrhage, may be sometimes be observed

Non-pharmacological Treatment 

  • Bed rest
  • Elevation of the affected part
  • Venous compression is recommended during the acute phase and subsequent weeks to reduce the risk of lymphedema
  • Prophylaxis  of  deep  venous  thrombosis  (DVT)  should  be  considered  depending  on presence of other risk factors

Pharmacological Treatment

A:  Weak  potassium  permanganate  soaks,  1:40000  (0.025%)  solution  12hourly  for  3–4days, with each session lasting for 15–20minutes 

AND 

A: silver sulfadiazine cream (topical) 12hourly 24hourly 

OR 

C: mupirocin (topical) 2% 12hourly for 5–7days 

OR  

C: fusidic acid (topical) 2% 12hourly for 5–7days 

AND  

A:  phenoxymethylpenicillin  (PO):  Adult  250–500mg;  paediatric 25mg/kg  6hourly  for  5–7days 

OR 

C: flucloxacillin + amoxicillin (FDC) (PO): Adult 500mg; paediatric 25–50mg/kg 6hourly for 5–7days 

AND 

A: ibuprofen 400mg (OP) 6hourly for 5days 

Referral: Refer if there are local or general signs of severity of developing necrotizing fasciitis