Last reviewed: 22 Jul 2024
Last updated: 05 Jan 2024
Summary
Definition
History and exam
Key diagnostic factors
- history of traumatic or nontraumatic cutaneous lesion
- anesthesia or severe pain over site of cellulitis
- fever
- palpitations, tachycardia, tachypnea, hypotension, and lightheadedness
- nausea and vomiting
- delirium
- crepitus
- vesicles or bullae
- gray discoloration of skin
- edema or induration
- location of lesion
Full details
Risk factors
- inpatient contact with index case
- Varicella zoster infection
- cutaneous injury, surgery, trauma
- nontraumatic skin lesions
- intravenous drug use
- chronic illness
- immunosuppression
- nonsteroidal anti-inflammatory drugs (NSAIDs)
Full details
Diagnostic tests
1st tests to order
- surgical exploration
- blood and tissue cultures
- gram stain
- complete blood count and differential
- serum electrolytes
- serum BUN and creatinine
- serum CRP
- serum creatine kinase (CK)
- serum lactate
- clotting screen
- arterial blood gas
Full details
Tests to consider
- radiography, CT/MRI, ultrasound
- fresh frozen section
Full details
Treatment algorithm
INITIAL
organism unknown
ACUTE
type I necrotizing fasciitis (polymicrobial)
type II necrotizing fasciitis due to group A streptococcus
type II necrotizing fasciitis due to Staphylococcus aureus
type II necrotizing fasciitis due to Vibrio vulnificus
type II necrotizing fasciitis due to Aeromonas hydrophila
type II necrotizing fasciitis due to mucorales
ONGOING
persistent cosmetic and functional defects after debridement
Contributors
Authors
Ramia Zakhour, MD
Assistant Professor
Department of Pediatrics
University of Texas
McGovern Medical School
Houston
TX
Disclosures
RZ declares that they have no competing interests.
Acknowledgements
Dr Ramia Zakour would like to gratefully acknowledge Dr Kevin Steiner and Dr William Petri previous contributors to this topic.
Disclosures
KS and WP declared they have no competing interests.
Peer reviewers
Felix Lui, MD, FACS
Associate Professor of Surgery
Yale School of Medicine
New Haven
VT
Disclosures
FL declares that he has no competing interests.
Shiranee Sriskandan, MA, MBBChir, FRCP, PhD
Professor of Infectious Diseases and Hon. Consultant
Section of Infectious Diseases
Imperial College London
London
UK
Disclosures
SS declares that she has no competing interests.
Differentials
- Cellulitis
- Impetigo
- Erysipelas
More DifferentialsGuidelines
- Global clinical pathways for patients with skin and soft tissue infections
- WSES/SIS-E consensus conference: recommendations for the management of skin and soft-tissue infections
More GuidelinesLog in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer