- A diagnosis of erysipelas cellulitis is rendered
- Blood work reveals a leukocytosis, elevated erythrocyte
- Admitted to hospital for intravenous antibiotics (penicillin
The general treatment strategy for erysipelas cellulitis is
In all cases, the therapeutic strategy is to eliminate the
pathogenic microorganism using an effective antimicrobial agent.
Penicillin antibiotics remain first-line for erysipelas. There is
sparse evidence supporting the use of particular antibiotic classes
for cellulitis; limited data suggests that macrolide antibiotics
may be more effective than penicillin antibiotics for cellulitis.
There is similarly limited data to support the use of intravenous
antibiotics over the use of oral antibiotics; in fact, there are
small studies demonstrating that oral therapies may be in some
cases more effective than intravenous treatment. Early data may
also support the use of prophylactic antimicrobial therapy
following an episode of leg cellulitis in patients who are high
risk of recurrence.
Patients with systemic symptoms, significant neutrophilia,
diabetes mellitus, immunosuppression, neutropenia, erysipelas of
the face, associated with decubitus ulcers, or cellulitis on
dependent extremities should be hospitalized and parenteral therapy
Follow-up evaluation strategy
- The following day, patient feeling better
- Significant reduction in erythema and edema of the left
- Fever resolved
- Discharge with 10-day course of oral amoxicillin
- Follow up in 10 days in outpatient clinic (resolved)
Erysipelas and cellulitis are infections of the dermis and
subcutaneous layers of the skin that are rapidly progressive and
are often accompanied by systemic signs, such as fever,
leukocytosis, and elevated markers of systemic inflammation.
The clinical presentation of erysipelas and cellulitis are
similar, presenting with unilateral erythema, edema, warmth, and
- Erysipelas affects the lower extremities (76% of cases) but
commonly has facial involvement (17%), is sharply demarcated,
typically involves more superficial lymphatics within the dermis to
give a waxy or intensely superficial edematous appearance.
- Cellulitis commonly affects the lower extremities, typically
affects one limb, and may result from an underlying abscess or
There is an important non-infectious differential diagnosis of
cellulitis, including contact dermatitis, venous stasis dermatitis,
deep vein thrombosis, and vasculitis. Venous stasis dermatitis is
commonly bilateral, and is not accompanied by signs of systemic
inflammation. Most cases of cellulitis are caused by streptococci.
Staphylococcus aureus is an important consideration in
cases of cellulitis associated with trauma or an underlying
Both erysipelas and cellulitis require systemic antibiotic
therapy. Although initial therapy is dictated by the likelihood
that the causative organisms are streptococci or, less likely,
S. aureus, in immunocompromised individuals, many other
organisms may be responsible. More serious soft tissue infections,
such as early necrotizing fasciitis, may resemble cellulitis.
Bailey E and Kroshinsky D. Cellulitis: diagnosis and management.
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Kilburn SA, et al. Interventions for cellulitis and erysipelas.
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Krasagakis K, et al. Analysis of epidemiology, clinical features
and management of erysipelas. Int J Derm 2010;49:1012-7.
UK Dermatology Clinical Trials Network's PATCH Trial Team.
Prophylactic antibiotics for the prevention of cellulitis
(erysipelas) of the leg: results of the U.K. Dermatology Clinical
Trials Network's PATCH II trial. BJD 2011. September 2011, e-pub
ahead of print.