Cellulitis and Erysipelas

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ICD10 CODE: L03

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.

Cause

  • Streptococcus and S.Aureus in adults
  • Haemophilus influenza type b in children under 3 years
  • Cellulitis is sometimes caused by other organisms e.g. pseudomonas picked from bath tubs to a lesser extent

Predisposing Factors

  • Minor trauma
  • Pre-existing lesion such as ulcer or erosion
  • Iatrogenic, via intra venous therapy (cannulation) and prolonged hospitalization

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 lymphadenitis 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

NB; Investigations depend on differential diagnosis  list, e.g. Xray, Doppler, CBC etc.

Management

Treatment LOC
  • 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
 HC3