Updated: 9/3/2017

Cellulitis

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Snapshot
  • A 12-year-old boy presents to the emergency room for a red, hot finger. He had suffered from a papercut a few days ago. On physical exam, his left middle finger is red, swollen, tender, and hot to the touch. The edges are not well-demarcated, but borders are drawn anyway to track the progress of the erythema. Blood cultures are negative. He is started on penicillin for suspected cellulitis.
Introduction
  • Clinical definition
    • painful bacterial infection involving the deeper dermis and subcutaneous tissues
      • often from Streptococcal spp. or, less commonly, S. aureus
    • from superficial involvement of skin to deep
      • impetigo (very superficial skin infection)
      • erysipelas (upper dermis and cutaneous lymphatics)
      • cellulitis (deeper dermis and subcutaneous tissues)
  • Epidemiology
    • incidence
      • 48 per 1000 person-years
    • risk factors
      • skin ulcers
      • tinea pedis
      • intravenous drug use
      • venous insufficiency
      • diabetes
      • lymphedema
      • pre-existing skin injury
  • Etiology
    • Streptococcus spp.
    • S. aureus
  • Pathogenesis
    • pre-existing injury in skin can act as entry portal for bacteria
  • Prognosis
    • recurrence
Presentation
  • Symptoms
    • painful and tense skin
  • Physical exam
    • fever
    • diffuse inflammation of affected area
      • poorly demarcated
      • red
      • warm
      • tender
      • dimpling around hair follicles resembling orange peel (peau d’orange)
Studies
  • Labs
    • blood cultures
  • Diagnosed clinically
Differential
  • Erysipelas
    • more superficial involvement of skin and soft tissues
    • there is often an overlap and may not be distinguished clinically from erysipelas
Treatment
  • Medical
    • oral antibiotics
      • indications
        • for mild cases of cellulitis
      • drugs
        • penicillin
        • dicloxacllin
        • cephalexin
        • clindamycin
          • for suspected methicillin-resistant S. aureus
    • IV antibiotics
      • indications
        • for cellulitis with signs of systemic infection
          • e.g., positive blood cultures
      • drugs
        • penicillin
        • cefazolin
        • ceftriaxone
        • clindamycin
Complications
  • Sepsis
 

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