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.