Cellulitis

Last Updated on by frcemuser

Cellulitis is an acute bacterial infection of the dermis and subcutaneous tissue. It presents with an acute onset of unilateral, red, painful, hot, swollen, and tender skin, with possible blister or bullae formation. Fever, malaise, nausea, and rigors may accompany or precede the skin changes. The leg is the most commonly affected site. The most commonly implicated organisms are Streptococcus pyogenes or Staphylococcus aureus.

Risk factors for developing cellulitis include:

  • A break in the skin e.g. insect bite, burn
  • Leg ulceration
  • Fungal infection between the toes
  • Concomitant skin disorder e.g. eczema
  • Lymphoedema
  • Venous insuficiency or oedema
  • Obesity

Risk factors for developing more severe infection include chronic renal or liver disease, diabetes mellitus, immunocompromise, alcohol misuse and neuropathy.

Complications of cellulitis include:

  • Necrotising fasciitis
  • Myositis
  • Subcutaneous abscess
  • Septicaemia
  • Persistent leg ulceration
  • Lymphoedema
  • Recurrent cellulitis

Consider admitting patients for intravenous antibiotics (e.g. flucloxacillin and benzylpenicillin) in those with severe or rapidly spreading cellulitis, patients who are systemically unwell, patients who are very young (< 1 years) or frail, immunocompromised patients or patients with facial or periorbital cellulitis. Patients with simple mild cellulitis may be managed at home with oral antibiotics. The area of cellulitis should be marked before treatment, inĀ  orderto monitor progress. Flucloxacillin is first line for most patients, co-amoxiclav is first line for mild facial cellulitis.

Erysipelas is a form of cellulitis involving more superficial dermal structures distinguished clinically by raised and well demarcated borders. The face or leg are most commonly affected. The rash begins as an erythematous patch which progresses rapidly to a fiery-red, indurated, tense, and shiny plaque. Most infections are with groupĀ  streptococci but Streptococcus pneumoniae, Klebsiella pneumoniae, Haemophilus influenzae type b, Yersinia enterocolitica and Moraxella spp. have been found. Treatment is the same as for cellulitis.

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