Erysipelas and Cellulitis: Causes and Treatments

Erysipelas and cellulitis are two infections with similar characteristics that develop when bacteria beyond the barrier of the skin, invading and infecting deeper tissues. The term cellulite cause some confusion to designate two different diseases. Those irregularities in the skin and fat accumulation of fluid that haunt both women, popularly known as cellulite is actually call medical hydrolipodystrophy gynoid (read: cellulite | How to get rid of cellulite?).

In this article we will talk about cellulite, skin infection, a lesion resembling erysipelas and that has nothing to do with cellulite cosmetic medicine.

How infections occur in the skin?

The skin is our main defense organization. It is the skin that keeps our inner environment isolated and prevents germs invade our bodies external environment. Any object or being in nature is full of bacteria, viruses, fungi and other germs on its surface. If we had no skin, our bodies would be in direct contact with germs and infections would continuously. Sepsis die immediately after birth and for thousands of years we would be extinct. It is no accident that all living beings have some sort of tissue paper to make the skin. If on one hand, inside the body is isolated from bacteria, on the other, our skin is full of these. Any material, whether organic or not, when exposed to the environment, takes its cargo of microbes. When we opened a wound in the skin, however small, there is a break in this barrier, exposing our inner germs from the external environment. The most common infections are those caused by bacteria that live naturally in our skin and take advantage of any injury to invade our subcutaneous tissues. Erysipelas and cellulitis are two bacterial infections affecting the inner layers of the skin, taking the same injury that serves as a gateway. Therefore, erysipelas and cellulitis are infections of the inner layers of the skin. If not treated properly, these invading bacteria can migrate to other body regions such as the bloodstream and internal organs.

What is the difference between erysipelas and cellulitis?

Look at the figure shown below, which represents the layers of the skin. The big difference between erysipelas and cellulitis is where the bacteria lodge and cause infection. In the case of erysipelas, infection occurs in the layer closest to the outside, affecting the skin and the outer layer of the dermis. However, cellulite is a deeper infection, infecting the fatty tissue in the hypodermis and the deep layer of the dermis.

Skin layers

Symptoms of erysipelas and cellulitis

Both lesions are very similar and sometimes difficult to be distinguished. Both erysipelas and cellulitis present clinically as a skin infection, that is, flushing (redness), local heat, intense pain and edema (swelling) in the affected area.

As erysipelas is more superficial infection than cellulitis, some features help in the differential diagnosis. In erysipelas, the lesion usually has a slight relief, and their edges are very sharp. In examining the skin is easy to know where it begins and ends where the infection. The demarcation between diseased skin and healthy skin is clear.

Cellulite, because it affects deeper tissues, no such clear signals on the skin. The injury is usually more diffuse and not always possible to know exactly where to begin and end the infection. Notice in the photo below, of cellulitis in the leg, how it is not so simple to know where in the foot there is no infection.

In erysipelas, systemic symptoms such as fever, sweats and chills often occur early, just come early signs of skin infection. In cellulite, the condition is usually more delayed, appearing first injury, and only after several days of fever. Other symptoms of infection may include loss of appetite, nausea, vomiting, malaise, anorexia and headache.

Erysipelas tends to occur more frequently in children and the elderly, whereas cellulite is more common in adults aged 50 years.

The lower limbs are the most affected both erysipelas and in cellulitis. However, any area of skin may be affected.

Curiosity, the ear is a part which has no tissues, therefore, an infection in this region can only be erysipelas.

In the most severe, the infection becomes more diffuse and the distinction between the two diseases is more difficult. Some signs of severity include blistering, ulceration and necrosis of the skin. Tables serious deep infections may evolve into osteomyelitis, which is infection of the bone. Another complication is endocarditis, infection of heart valves by bacteria that migrate through the bloodstream.

If left untreated, cellulitis and erysipelas may develop into sepsis with high risk of death for the patient.
Erysipelas usually affects the lymph vessels of the skin and can cause lymphedema. When infection occurs chronically, the destruction of these vessels can lead to chronic edema box similar to what occurs in elephantiasis (filariasis). It is a very common injury in people living on the street, especially in the elderly. The lymphatic edema is a typical complication of erysipelas of repetition, but can also occur in cellulite.

Risk factors for erysipelas and cellulitis

As already mentioned earlier in this text, any injury to serve as a gateway for bacteria, it becomes a risk factor for developing skin infections. Among the most common can include:

– Cuts and simple wounds.
– Athlete’s foot.
– Eczema.
– Impetigo.
– Varicella or other skin eruptions.
– Pimples (acne).
– Mosquito bites.
– Ingrown nails or any other injury to the nail.
– Use of intravenous drugs.
– Burns.
– Animal bites.
– Implementation of piercings.

In addition to skin lesions, other factors associated with an increased risk of erysipelas and cellulitis:

– Obesity.
– Diabetes.
– Use of corticosteroids.
– Immunosuppression.
– Patients with chronic edema (any cause).

What is causing erysipelas and cellulitis?

Two bacteria that live on our skin are responsible for more than 80% of cases of cellulitis and erysipelas. Are Streptococcus and Staphylococcus. Staphylococcus MRSA, a resistant form of the bacteria can also cause skin infections. Erysipelas is usually caused by Streptococcus and Staphylococcus cellulite. This, however, is not a rule. Several other bacteria may be responsible for the painting, including Haemophilus influenzae, Yersinia enterocolitica, Streptococcus pneumoniae, Klebsiella pneumoniae, Pasteurella multocida, Pseudomonas aeruginosa and Clostridium.

Treatment of erysipelas and cellulitis

Since this bacterial infections, the treatment must be these two infections with antibiotics. The initial regimen should include a drug with action on the Streptococcus and Staphylococcus.

The choice of antibiotics by mouth or intravenously should be done in accordance with the severity of the case. Facial injuries, serious injury or in patients with immunosuppression should preferably be treated with intravenous drugs.

The treatment time is usually 14 days.

Drugs are chosen mainly penicillin and its derivatives. Some options include cephalexin, flucloxacillin, dicloxacillin, amoxicillin, oxacillin and cephalothin. Those allergic to penicillin can be treated with erythromycin or clindamycin.

In cases with suspected MRSA Staphylococcus (Staphylococcus resistant), treatment should be performed with intravenous vancomycin.

The appropriate antibiotic should be chosen by your doctor and the scheme may vary from region to region according to the resistance profile of bacteria.

In addition to antibiotics, rest and elevation of the affected limb are important because they help reduce swelling and relieve pain.

In cases of recurrent erysipelas, in which not controlled risk factors, may be given prophylactic treatment with a dose of benzathine penicillin (Benzetacil) every month for several months.