Cellulitis vs Erysipelas
Cellulitis and Erysipelas are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Cellulitis vs Erysipelas at a glance
- Cellulitis: Acute bacterial infection of the dermis and subcutaneous tissue, most often caused by beta-hemolytic streptococci or Staphylococcus aureus.
- Erysipelas: Superficial cellulitis with prominent lymphatic involvement, sharply demarcated borders, and a classic 'peau d'orange' appearance — almost always streptococcal.
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Side-by-side comparison
| Feature | Cellulitis | Erysipelas |
|---|---|---|
| At a glance | Acute bacterial infection of the dermis and subcutaneous tissue, most often caused by beta-hemolytic streptococci or Staphylococcus aureus. | Superficial cellulitis with prominent lymphatic involvement, sharply demarcated borders, and a classic 'peau d'orange' appearance — almost always streptococcal. |
| Classic presentation | Unilateral lower-leg cellulitis is extremely common; bilateral lower-leg 'cellulitis' is almost never cellulitis — consider stasis dermatitis,… | A sharply demarcated, raised, fiery red facial or leg plaque with a clear edge ('the lesion you can trace') and a high fever — classic erysipelas.; Abrupt… |
| Workup / key labs | Clinical diagnosis. IDSA stratifies into mild, moderate, severe and purulent vs non-purulent for treatment selection.; CBC, BMP, lactate if systemic toxicity;… | Clinical: sharply demarcated, raised, brightly erythematous, warm, tender plaque with systemic symptoms.; Clinical diagnosis — labs not routinely required;… |
| Imaging | Bedside ultrasound to differentiate cellulitis (cobblestoning) from abscess (anechoic collection); Plain films for foreign body, soft tissue gas (necrotizing… | Not required for typical presentations; Ultrasound to exclude abscess if purulence suspected |
| First-line treatment | Non-purulent cellulitis (likely beta-hemolytic strep):; • Mild outpatient: oral beta-lactam — cephalexin 500 mg PO QID, dicloxacillin 500 mg PO QID, or… | Penicillin remains drug of choice — narrow spectrum, predictable streptococcal coverage:; • Oral: penicillin VK 500 mg PO QID or amoxicillin 500 mg PO TID ×… |
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