Cellulitis And Erysipelas
Description Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: L03.9/A46 DESCRIPTION Infection of the skin and subcutaneous tissue usually caused by streptococci, staphylococci or H. influenzae . In cellulitis, the border of the lesion is indistinct. Erysipelas The affected area is: well demarcated with clear borders, very tender and wa
General and supportive measures
ICD-10 code: L03.9/A46
DESCRIPTION
Infection of the skin and subcutaneous tissue usually caused by streptococci, staphylococci or H. influenzae. In cellulitis, the border of the lesion is indistinct.
Erysipelas
The affected area is:
- well demarcated with clear borders,
- very tender and warm,
- bright red and swollen.
Erysipelas must be distinguished from necrotising fasciitis, where there is infection and inflammation by a gas-forming organism that spreads rapidly along the fascial tissue.
Complications include septicaemia.
DIAGNOSTIC CRITERIA
- Acutely ill child with fever and malaise.
- Affected area is swollen, indurated, erythematous and tender, with regional lymphadenopathy.
GENERAL AND SUPPORTIVE MEASURES
- Ensure adequate nutrition and hydration.
- Elevate the affected limb to reduce swelling.
- Exclude eczema, an immunocompromised state, diabetes and underlying osteomyelitis.
MEDICINE TREATMENT
Choice of intravenous or oral antibiotics depends on the severity of the condition.
Severe disease
- Cloxacillin, IV, 50 mg/kg/dose 6 hourly for 5 days.
Non-severe disease
- Cephalexin, oral, 25 mg/kg/dose 6 hourly for 7 days.
Where weight is unknown:
◦ Child < 2 years: 125 mg.
◦ Child 2–10 years: 250 mg.
◦ > 10 years: 500 mg.
OR
- Flucloxacillin, oral, 25 mg/kg/dose 6 hourly for 7 days.
Penicillin allergy:
- Clindamycin, oral, 6 mg/kg/dose, 6 hourly for 10 days.
For pain:
- Paracetamol, oral, 15 mg/kg/dose, 6 hourly as required.
If needed, ADD
- Ibuprofen, oral, 5–10 mg/kg/dose, 6–8 hourly for 72 hours.
- Child < 30 kg, maximum dose: 500 mg/day.
REFERRAL
- Urgent: necrotising fasciitis.
- Poor response to therapy.
- Recurrent cellulitis.
Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter 5: Dermatology, 5.3 Macules And Papules, 5.3.3 Cellulitis And Erysipelas