Erysipelas and cellulitis are acute, spreading infections of dermal and subcutaneous tissues, characterized by a red, hot, tender area of skin, often at the site of bacterial entry, caused most frequently by group A β-hemolytic streptococci (erysipelas) or Staphylococcus aureus.
Causes of Erysipelas and Cellulitis
After entry, infection spreads to tissue spaces and cleavage planes as hyaluronidases break down polysaccharide ground substances, fibrinolysins digest fibrin barriers, lecithinases destroy cell membranes. Local tissue devitalization, e.g., trauma, is usually required to allow for significant anaerobic bacterial infection. The number of infecting organisms is usually small, suggesting that cellulitis may be more of a reaction to bacterial superantigens than to overwhelming tissue infection.
Symptoms of Erysipelas and Cellulitis
Symptoms include – Face — red, usually glossy appearance; swollen, hot, may or may not have blisters. Pain . Fever. Chills. Feel ill.
Diagnosis
Clinical diagnosis. Confirmed by culture in only 25% of cases in immunocompetent patients. Suspicion of necrotizing fasciitis requires immediate deep biopsy and frozen-section histopathology.
Treatment
Prophylaxis
Individuals with prior episodes of cellulitis Especially in sites of chronic lymphedema: support stockings, antiseptics to skin, chronic secondary antimicrobial prophylaxis (penicillin G, dicloxacillin, or erythromycin, 500 mg/d).
Status postsaphenous vein harvest Especially with tinea pedis: Wash with benzoyl peroxide bar daily, followed by application of topical antifungal cream.
Pneumococcus Immunize those at risk.
HIb Chemoprophylaxis for household contacts <4 years of age if unimmunized.
Vibrio spp. Diabetics, alcoholics, cirrhotics should avoid eating undercooked seafood.
Supportive Rest, immobilization, elevation, moist heat, analgesia
Surgical Intervention Drain abscesses. Debride necrotic tissue. With felon, surgical drainage is required for later lesions to interrupt the cycle of inflammatory-ischemic events.
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