ERYSIPELAS vs CELLULITIS

ERYSIPELAS

- edematous, spreading, circumscribed, hot, erythematous area, with or without vesicles or bullae
- characteristically raised advancing edges and sharply demarcated borders, reflecting its more superficial nature- the lesion doesnt usually become pustular or gangrenous and heals without scar formation
- central face frequently involved
- pain, chills, fever, and systemic toxicity maybe striking
- LAB : leukocytosis is almost invariably present

TREATMENT
- Penicillin G procaine: 0.6-1.2 million U IM bid for 10 d,Penicillin VK: 250-500 mg PO qid for10-14d
- Erythromycin : Adult 250-500 mg PO qid for 10 d, Pediatric 30-50 mg/kg/d (15-25 mg/lb/d) PO q6-8h
- Clindamycin   : Adult 300-450 mg PO qid, Pediatric 16-20 mg/kg/d PO q6-8h
- Elevation and rest of the affected limb are recommended in erysipelas treatment to reduce local swelling, inflammation, and pain.
- Saline wet dressings should be applied to ulcerated and necrotic lesions and changed every 2-12 hours, depending on the severity of the infection.

CELLULITIS 

- edematous, expanding, erythematous, warm plaque with or without vesicles or bullae
- the margin of cellulitis is not palpable. A disease similar to cellulitis, but with a sharply defined, palpable margin is erysipelas.- lower leg is frequently involved
- pain, chills, and fever are commonly present
- septicemia may develop
- regional lymphadenopathy may be present
- fever may be present
- cellulitis was classically considered to be infection of the skin and subcutaneous tissues manifesting as warmth, tenderness, erythema, and edema without formation of abscess and without exhibiting purulent drainage or ulceration
- LAB : Leucocytosis or etleast a neutrophilia (left shift)

TREATMENT (combination antibiotic more effective!)

- Amoxicillin and clavulanate : Adult 500-875 mg PO q12h or 250-500 mg PO q8h for 7-10 d
- Clindamycin : Adult 150-300 mg/dose PO q6-8h; not to exceed 1.8 g/d; alternatively, 600 mg IV divided q8h, depending on degree of infection; not to exceed 4.8 g/d, Pediatric : 8-20 mg/kg/d PO as hydrochloride and 8-25 mg/kg/d as palmitate divided tid/qid
- Sulfamethoxazole and trimethoprim :  Adult 160 mg TMP/800 mg SMZ PO q12h for 10-14 d ,
  Pediatric <2 months: Do not administer , >2 months: 10-20 mg TMP/kg/d PO/IV divided tid/qid for 14d
- Ciprofloxacin (Cipro) : Adult 250-500 mg PO bid for 7-14 d , Pediatric <18 years: Not recommended
  >18 years: Administer as in adults
- Ceftriaxone : Adult1-2 g IV/IM qd or divided bid, depending on type and severity of infection; not to    exceed 4 g/d,  PediatricNeonates >7 days: 25-50 mg/kg/d IV/IM divided bid; not to exceed 125 mg/d
Infants and children: 50-75 mg/kg/d IV/IM divided bid; not to exceed 2 g/d
- Metronidazole
- Ampicillin