Cellulitis and erysipelas
Summary
Definition
History and exam
Key diagnostic factors
- skin discomfort
- macular erythema
- disruption of cutaneous barrier
- raised bright-red erythema with clearly demarcated margins (erysipelas)
- risk of infection with MRSA
Other diagnostic factors
- history of diabetes
- constitutional prodrome
- lymphangitis/regional lymphadenopathy
- identifiable port of entry
- history of immunocompromise
- unusual exposure (salt or fresh water, bite)
危险因素
- diabetes
- venous insufficiency and chronic leg edema
- dermatosis
- lymphedema
- prior episode of cellulitis
- toe web abnormalities
- intravenous drug use
- overweight
- military service
诊断性检查
首要检查
- CBC
- purulent focus culture and molecular diagnostic procedures
需考虑的检查
- skin aspiration with culture and molecular diagnostic procedures
- blood cultures
- skin biopsy
- plain film x-ray
- ultrasound
- CT scan
- MRI
治疗流程
mild
moderate
severe
treatment failure
frequent relapses
撰稿人
专家顾问
Arash Mostaghimi, MD, MPA, MPH
Associate Professor of Dermatology
Harvard Medical School
Vice Chair, Clinical Trials and Innovation
Director, Inpatient Consultation Service
Department of Dermatology
Brigham and Women’s Hospital
Boston
MA
利益声明
AM has received fees or honoraria for consulting from hims and hers, AbbVie, Sun Pharma, Pfizer, Digital Diagnostics, Lilly, Equillium, ASLAN, Boehringer Ingelheim, Figure 1, Dermatheory, Olaplex, and Legacy Healthcare.
鸣谢
Dr Arash Mostaghimi would like to gratefully acknowledge Dr Matthew C. Robinson, the previous contributor to this topic.
利益声明
MCR declares that he has no competing interests.
同行评议者
Robert W. Bradsher, MD
Ebert Professor of Medicine
Director
Division of Infectious Diseases
University of Arkansas for Medical Sciences
Little Rock
AR
利益声明
RWB declares that he has no competing interests.
Jorg Ruhe, MD, MPH
Assistant Attending
Beth Israel Medical Center
New York
NY
利益声明
JR declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
Raff AB, Kroshinsky D. Cellulitis: a review. JAMA. 2016 Jul 19;316(3):325-37. 摘要
Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014 Jul 15;59(2):e10-52.全文 摘要
American College of Radiology. ACR appropriateness criteria: suspected osteomyelitis, septic arthritis, or soft tissue infection (excluding spine and diabetic foot). 2022 [internet publication].全文
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Necrotizing fasciitis
- Thrombophlebitis, superficial
- Deep vein thrombosis
更多 鉴别诊断指南
- 2018 WSES/SIS-E consensus conference: recommendations for the management of skin and soft-tissue infections
- Practice guidelines for the diagnosis and management of skin and soft tissue infections
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