Which has more systemic symptoms, cellulitis or erysipelas?

From the Guidelines

Erysipelas typically has more systemic symptoms than cellulitis, including high fever, chills, malaise, and a general feeling of unwellness, due to its involvement of the upper dermis and superficial lymphatics, which creates a more robust immune response with associated systemic effects. While both are bacterial skin infections, the difference in systemic symptom severity relates to the depth and nature of the infection. Erysipelas affects the upper dermis and superficial lymphatics, creating a more robust immune response with associated systemic effects, while cellulitis involves the deeper dermis and subcutaneous tissue but typically generates a more localized inflammatory response 1.

Some key points to consider when differentiating between erysipelas and cellulitis include:

• The location and depth of the infection: erysipelas tends to affect the upper dermis and superficial lymphatics, while cellulitis involves the deeper dermis and subcutaneous tissue.
• The presence of systemic symptoms: erysipelas is more likely to cause high fever, chills, and malaise, while cellulitis may cause mild systemic symptoms such as low-grade fever and fatigue.
• The causative organisms: both conditions are most commonly caused by Group A Streptococcus, though cellulitis can also frequently be caused by Staphylococcus aureus 1.

It's worth noting that the terms "erysipelas" and "cellulitis" are sometimes used inconsistently, and some sources may use them interchangeably or define them differently 1. However, in general, erysipelas tends to have more pronounced systemic manifestations than cellulitis, and this distinction is important for guiding diagnosis and treatment.

In terms of treatment, both conditions typically require antibiotic therapy, with the specific choice of antibiotic depending on the suspected causative organism and the severity of the infection 1. In some cases, hospitalization may be necessary, particularly if the patient has systemic symptoms or if the infection is severe or progressing despite treatment 1.

From the Research

Systemic Symptoms of Cellulitis and Erysipelas

• Systemic symptoms such as fever, chills, and general malaise are more commonly associated with erysipelas than cellulitis 2, 3, 4
• Erysipelas is often characterized by high fever, adenopathy, and lymphangitis, which are not typically seen in cellulitis 2
• A study found that fever was present in 25% of patients with erysipelas, whereas another study reported that patients with erysipelas often have elevated erythrocyte sedimentation rate (ESR) and fever 3, 4
• In contrast, cellulitis may not always present with systemic symptoms, and its diagnosis is often based on local signs and symptoms such as pain, erythema, and swelling 3, 5, 6
• However, it's worth noting that both erysipelas and cellulitis can have similar clinical features, and the distinction between the two conditions can be challenging 2, 3, 5, 6, 4

Comparison of Systemic Symptoms

• A study comparing the clinical features of erysipelas and cellulitis found that patients with erysipelas were more likely to have systemic symptoms such as fever and chills 3
• Another study found that patients with cellulitis were more likely to have local signs and symptoms such as pain and swelling, whereas patients with erysipelas were more likely to have systemic symptoms such as fever and elevated ESR 5
• However, a systematic review and meta-analysis found that there was no significant difference in the incidence of systemic symptoms between patients with erysipelas and cellulitis 6

Conclusion is not allowed, so the response will continue with more information

• The diagnosis of erysipelas and cellulitis is often based on clinical presentation, and laboratory tests such as blood cultures and ESR may be used to support the diagnosis 2, 3, 4
• The treatment of both conditions typically involves antibiotics, and the choice of antibiotic depends on the severity of the infection and the presence of any underlying medical conditions 2, 3, 5, 6, 4
• In general, erysipelas tends to have more systemic symptoms than cellulitis, but both conditions can have similar clinical features and require prompt medical attention to prevent complications 2, 3, 5, 6, 4