Cellulitis
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Introduction
Cellulitis is a skin infection affecting the connective tissue layer of the dermis.
The Case of...
a simple case introducing clincial presentation and calling for a differential diagnosis to get students thinking.
Causes and Risk Factors
Cellulitis often follows breaches in the skin such as abrasions, lacerations, IV catheters, etc. It can take as little as 24 hours to develop.
The most common causes include S. pyogenes and Staph. aureus.
Pathophysiology
Signs and Symptoms
- history
- physical exam
History
Physical Exam
Rarely bilateral
Look for evidence of purulence; this suggests Streptococcus, rather an Staphylococcus.
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
Blood cultures should be carried out if sepsis is a potential concern.
Diagnostic Imaging
Differential Diagnosis
Treatments
Cephalexin is normally used. If MRSA is suspected; TMP/SMX, clindamycin, doxycycline, or linezolid.
Coverage of Staphylococcus often leads to the use of cloxacillin. If cellulitis is more severe, cloxacillin can be used in combination with penicillin or ampicillin.
If systemic symptoms are present, eg fevers, rigors, or evidence of SIRS, IV antibiotics may be required in severe cases, along with tissue debridement if necessary.
Pain control should be provided with acetaminophen or ibuprofen.
Consequences and Course
Properly treated cellulitis will often resolve within a week. However, serious cases can take months to clear, or can lead to severe disability and death if sepsis develops.
Cellulitis can recur, especially if improperly treated.
Resources and References
Topic Development
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