Erysipelas, Cellulitis, Lymphangitis

Presentation

Erysipelas is a superficial cutaneous infection commonly found on the legs or face and generally does not have an inciting wound or skin lesion. Erysipelas appears as a painful, fiery-red induration with raised and sharply demarcated borders, at times giving the skin a pitted appearance like an orange peel (peau d’orange) ( Fig. 168.1 ). In contrast, cellulitis involves the subcutaneous connective tissue and has an indistinct advancing border. This deeper infection is characterized by pain and tenderness and by warmth and edema, giving the skin a light red or pink appearance ( Fig. 168.2 ). Cellulitis can occur on any part of the body but is most common on the legs, face, feet, and hands. Lymphangitis has minimal induration and an unmistakable erythematous linear pattern ascending along lymphatic channels ( Fig. 168.3 ).

These relatively superficial skin infections ( Fig. 168.4 ) are often preceded by minor trauma, such as an abrasion or the presence of a foreign body. All three conditions are more common in patients with predisposing factors (e.g., diabetes, substance abuse, alcoholism, immunosuppression, vascular insufficiency, and lymphatic drainage obstruction). These conditions may be associated with an abscess or other dermatologic abnormality, such as tinea pedis, impetigo, or folliculitis. The etiology is often unclear. With any of these skin infections, the patient may have tender lymphadenopathy proximal to the site of infection and may or may not have signs of systemic toxicity (fever, chills, rigors, and listlessness).