Last reviewed: 13 Oct Last updated: 18 Jun Key diagnostic factors acute onset of red, painful, hot, swollen skin cellulitis well-demarcated, bright-red raised skin erysipelas Full details. Other diagnostic factors orange-peel appearance blistering bleeding lymphangitis unilaterality fever malaise lymphadenopathy toe-web abnormalities risk factors other constitutional symptoms source of infection immunocompromising factors recent travel fluctuance deep to the cellulitis dermal necrosis signs of sepsis signs of necrotising fasciitis signs of orbital or peri-orbital cellulitis Full details.
Risk factors diabetes venous insufficiency eczema oedema and lymphoedema obesity previous episodes of cellulitis toe-web abnormalities Full details. Investigations to consider skin swab skin aspirate skin biopsy molecular diagnostic procedures plain x-ray MRI ultrasound liver function tests Full details. Acknowledgements BMJ Best Practice would like to gratefully acknowledge the previous expert contributor, whose work has been retained in parts of the content: Matthew C.
Differentials Necrotising fasciitis Thrombophlebitis, superficial Deep vein thrombosis More differentials. Appropriate use of short-course antibiotics in common infections: best practice advice from the American College of Physicians external link opens in a new window Cellulitis and erysipelas: antimicrobial prescribing external link opens in a new window More guidelines.
Patient leaflets external link opens in a new window Cellulitis and erysipelas More patient leaflets. I have some feedback on: Feedback on: This page The website in general Something else. I have some feedback on:. There are some things that can make you more prone to cellulitis.
For example, if you:. The photo below shows the slightly less serious infection, erysipelas, on a lady's face. Erysipelas is more likely on the face than cellulitis, and often goes across the nose and cheeks:. Book a private appointment with a local pharmacist today to discover treatment options. The infection in the skin causes swelling. It is this swelling that is painful, because it presses the skin out.
In general, cellulitis can be treated effectively at an early stage with antibiotics and does not normally become a serious problem in developed countries. If the person has a particularly weak immune system - for example, from medications that suppress the immune system, or from HIV - then it could become serious.
So, the 'take home message' is: if you have a patch of skin that is red, warm and seems to be getting larger, see a doctor as soon as possible. With treatment, most people with cellulitis make a full recovery without any complications developing. A course of antibiotic tablets will usually clear cellulitis. Usually it is sufficient to take a week of antibiotic tablets. The usual course would be a week, followed by a second week if it hadn't cleared.
Sometimes it will be necessary to be given antibiotics through a vein intravenous antibiotics. This would be necessary if you had a high temperature fever from the cellulitis, or had bad shivering. Your doctor will assess whether they think intravenous antibiotics are necessary.
Raising elevating your affected body part uses gravity to help prevent excess swelling, which may also ease pain.
Do this as much as possible until the infection clears. If you have a cellulitis of the leg , 'raised' means that your foot is higher than your hip so gravity helps to reduce the swelling. When they are told to elevate a leg, many people put their leg on a chair or footstool. This is rarely sufficient even if the chair reclines , as the ankle has to be higher than the hip for elevation to be useful. The easiest way to raise your leg is to lie on a sofa with your heel up on the arm of the sofa but avoid pressure on the calf.
Or, lie on a sofa with your foot on two or three thick cushions. When in bed, put your foot on several pillows so that it is higher than your hip. Alternatively, empty a deep drawer and put it under the mattress at the foot of your bed. You may need to keep your foot elevated as much as possible for a few days.
However, to aid circulation, you should go for short walks every now and then and wiggle your toes regularly when your foot is raised. If you have cellulitis in a forearm or hand , a high sling can help to raise the affected area. As the infection starts to clear up and the fever subsides it is usually possible, after 3—5 days, to switch over to oral medication 1—1. A total period of treatment of 10—14 days is usually sufficient. If there has been a consistent response to treatment, antimicrobial medication can often be withdrawn even if there is still slight erythema and oedema.
If the response is slow, in high-risk patients and in the case of recurrent erysipelas, the total duration of antimicrobial treatment can be extended to 3 weeks. Streptococci found in blood culture usually require 7—10 days of intravenous antimicrobial treatment.
In addition to antimicrobial treatment, symptoms can in the initial phase be alleviated by moist compresses applied 2—3 times daily, for example. For patients hypersensitive to penicillin: cephalosporins if there has been no anaphylactic reaction to penicillin : 1.
Cellulitis Cellulitis resembles erysipelas but the inflamed area extends deeper into the adipose tissue with ulcerations, suppurative areas and abscesses. There may also be cellulitis spreading from an abscess or a purulent or surgical wound infection.
If the skin infection was purulent or clearly ulcerative from the very beginning, antimicrobial treatment must also cover Staphylococcus aureus see below. If the patient is in a good general condition, oral antimicrobial treatment may be sufficient, the duration of treatment being the same as for erysipelas. For patients requiring hospital treatment, intravenous treatment will be needed at first. An essential part of treating an abscess is incision «Skin abscess and folliculitis» 1.
In the case of a septic clinical picture, intravenous clindamycin may be added to the therapy. Recurrent erysipelas If erysipelas recurs frequently, long-term prophylactic therapy needs to be considered.
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