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Soft Tissue Infection & Abscess Formation

Cellulitis and Erysipelas

This is a bacterial infection of the dermis and subcutaneous tissue. It's important to look out for a breach in the skin barrier or a point of bacteria entry, which may be due to trauma, eczema, ulcers, sores etc.


Risk factors - Age, Immunocompromised, Predisposing skin conditions e.g. eczema


It's usually caused by Staph or Strep organisms.

  • A golden-yellow crust indicates a staph infection (similar to impetigo)


Cellulitis presents with

  • Erythema – Poorly demarcated margins

  • Warm

  • Oedema

  • Thickened

  • Systemic symptoms - Fever, Malaise

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“Cellulitis of the leg.” © Pshawnoah CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0/)

Erysipelas only involves and dermis and upper part of the subcutaneous tissue, therefore making it a more superficial type of cellulitis. It differs in presentation as the erythema has well demarcated margins instead.

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“Erysipelas on a hairy leg.” © Tommi Nummelin CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0/)

Investigations:

  • Bloods - including culture

  • Skin swab for culture


Management:

  • Mark area of erythema to assess improvement/worsening of cellulitis

  • Elevation (reduces swelling and speeds healing)

  • Flucloxacillin 1st line - Very effective against staph infections

    • Clarithromycin, Clindamycin, Co-amoxiclav are other options



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