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Updated: Jan 16 2022


  • 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
    • Lymphedema
      • asymptomatic non-pitting edema of the extremities
        • best treated initially with conservative measures such as compression stockings
  • 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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