P1: OXT/OZN/JDO P2: PSB
0521779407-E-01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:10
544 Erysipelas and Cellulitis➣Sharply marginated warm, tender, erythematous, edematous,
indurated plaque
➣Fever, often to 102 degrees F
➣Vesicles or bullae may occur on the surface.
■Cellulitis
➣Most often on the extremities
➣Evidence of onychomycosis is frequent and may represent the
site of entry for the bacteria.
➣Less well demarcated than erysipelas, but otherwise the findings
are identical
■Perianal cellulites
➣Usually in young children
➣May precede a flare of guttate psoriasis
tests
Laboratory
■Basic blood studies:
➣Leukocytosis is frequent.
➣Streptozyme (ASO) titer is frequently elevated.
■Biopsy is not necessary, but reveals edema, dilated capillaries, and
diffuse neutrophilic infiltration.
■Cultures
➣may be obtained by needle aspiration or biopsy
➣blood cultures may reveal pathologic bacteria
Confirmatory Tests
■Diagnosis is clinical.
Imaging
■Not needed
differential diagnosis
■Thrombophlebitis
■Necrotizing fasciitis
■Gout
■Sweet’s syndrome
■Scurvy
management
What to Do First
■Assess the need for intravenous antibiotic therapy.
General Measures
■Elevation of the inflamed area
■Cool, moist compresses