42 CLINICAL
Serious skin infections in primary care
Can you identify the causes of these potentially worrying skin presentations ? Answers in the box below
1
A 45-year-old woman with diabetes is concerned about redness on her foot . What is the problem ?
Cellulitis Erysipelas Eczema herpeticum Septic arthritis
2
A young child is brought to see you with clusters of itchy and painful blisters – he is known to have eczema but is otherwise healthy . What lies behind the presentation ?
Cellulitis Erysipelas Eczema herpeticum Septic arthritis
3
A 56-year-old man has presented with a sudden onset of this rash . He feels unwell and has a fever . What could be the cause ?
Cellulitis Erysipelas Eczema herpeticum Septic arthritis
4
A 35-year-old man has consulted with sudden-onset knee pain . He is feeling generally unwell . What is the possible diagnosis ?
Cellulitis Erysipelas Eczema herpeticum Septic arthritis
Answers 1 Cellulitis An acute bacterial infection of the dermis and subcutaneous tissue usually caused by Streptococcus pyogenes or Staphylococcus aureus . Risk factors include chronic leg oedema and diabetes ; management is usually with oral or intravenous penicillin-based antibiotics . 2 Eczema herpeticum This is a viral complication of eczema . It is considered to be a dermatological emergency and the patient should be seen in secondary care to consider admission . 3 Erysipelas This is a superficial form of skin infection that tends to come on suddenly ; the patient may have a fever or experience chills or shivering . It is usually caused by group A beta-haemolytic streptococci and is treated with oral or intravenous penicillin-based antibiotics . 4 Septic arthritis The initial differential diagnosis would include gout . Septic arthritis is an orthopaedic emergency , and the patient should be referred to secondary care for investigation and likely intravenous antibiotics .
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