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Cellulitis: a common acute bacterial infection of the lower dermis and…
Cellulitis: a common acute bacterial infection of the lower dermis and subcutaneous tissue.
Characteristics
blisters and bullae may form
may present with systemic symptoms- fever, rigors, malaise, nausea
most commonly lower limbs
infected are red, painful, erythema
usually unilateral
Complications
sepsis
persistent leg ulceration
necrotizing fasciitis
recurrent cellulitis
gas gangrene
endocarditis
infections - pneumonia, osteomyelitis
Risk factors
Immunodeficient and immunosupressant medication
current or prior injury
CKD and chronic liver disease, diabetes
venous disease
fissuring of toes/heeld
previous episodes of cellulitis
obesity. pregnancy
Cause
Streptococcus pyogenes account for 70% cases
Staphylococcus aureus approx 30 % of cases
Management
ERON classification tool
Class 1 in primary care- Oral Abx
Class III - hospital admission- significant systemic upset
Class II - short period hospitalization or OPAT
Class IV - hospital admission - sepsis or life threatening illness
Abx - Flucloxacillin or Doxycyline
manage comorbidities e.g diabets
lifestyle advice e.g weight loss
management of coexisting skin conditions
Analgesia for pain/pyrexia
adequate fluid intake
Recurrent cellulitis
Skin care and hygiene - emollients, podiatry
treat fungal infections early
Avoid trauma
manage oedema and lymphoedema- compression liners
Differential
Ruptured bakers cyst
Septic arthritis
DVT
acute gout
thrombophlebitis
erysipelas
psoriasis
eczema
Diagnosis
Hx of symptoms
Assessment skin for breaks, diffuse redness, blisters, bruising, petechiae, dermal necrosis, lymphoedema, lymphadenopathy,. BP, TPR and SpO2
PMhx
Investigations if warranted - wound swab, or diagnosising underlying comorbidities
Red Flags
Systemic upset - hypotension, tachycardia, acute confusion
DVT - wells score>
necrotizing fasciitis
Referral
Urgent hospital admission: Class III and IV, life threatening infection and comorbidities, facial cellulitis suspected orbital or periorbital cellulitis
References:
https://dermnetnz.org/topics/cellulitis/
cks.nice.org.uk/cellulitis