Page 24 - LECTURE NOTES

Clinical features

The difference between the conditions is often times fluid and more of academical.

Except in mild cases, there is constitutional upset with fever and malaise. Classical
erysipelas starts abruptly and systemic symptoms may be acute and severe, but the

response to treatment is more rapid. Erythema, heat, swelling and pain or tenderness
are constant features in both. In erysipelas, the edge of the lesion is well demarcated

and raised, but in cellulitis it is diffuse.

In erysipelas, blisters are common and severe cellulitis may also show bullae or
necrosis of epidermis and can rarely progress to fasciitis or myositis. Lymphangitis and

lymphadenopathy are frequently associated with cellulitis.

The leg is the commonest site for cellulites. A skin break, usually a wound even if

superficial, an ulcer, or an inflammatory lesion including interdigital fungal or bacterial
infection, may be identified as a portal of entry.

Erysipelas may occur on the face or extremities and usually accompanied by malaise
and fever.

Complications

Without effective treatment, complications are common - fasciitis, myositis,
subcutaneous abscesses, and septicemia. Pretibial cellulitis can result in osteomyelitis

from contiguous spread. Post streptococcal glomerulonephritis can occur in some

cases.
If Lymphangitis is not treated properly, it can lead to lymphoedema.

Management

Treat the fever and pain and elevate the affected part.
Crystalline penicillin or procaine penicillin is the first line therapy and oral Ampicillin or

Amoxicillin may be used for mild infection and after the acute phase resolves. The
antibiotics should be continued for 10- 14 days.

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