Clinical Features
The image of erysipelas is reproduced with permission from Wellcome Images.
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Both erysipelas and cellulitis present with the following:
Type of lesion
- Red, oedematous tender spreading areas, which are well demarcated in erysipelas but diffuse in cellulitis. There may be small haemorrhagic areas
- Sometimes lymphangitis and regional lymphadenopathy
- Vesicles/bullae are fairly common
- Entry wound, bite, septic source or pre-existing skin pathology such as venous eczema or athlete’s foot is often apparent
Systemic features
- Usually mild
- Fever, tachycardia, confusion, hypotension, and leukocytosis are sometimes present and may precede visible skin changes
Anatomic location
- Commonest site is the leg – usually unilateral, but bilateral cellulitis does occur rarely
- Arm and breast cellulitis occur after mastectomy
Predisposing factors
Predisposing factors include:
- Diabetes
- Immunodeficiency (more atypical organisms, e.g. pseudomonas aeruginosa)
- Varicella infection
- Systemic illness
- Impaired peripheral circulation (arterial or venous insufficiency)
- Lymphoedema
- Obesity
Learning bite
Always consider necrotising fasciitis if the patient is systemically unwell and the cellulitis is spreading rapidly.