Last reviewed: December 2018
Last updated: June  2018

Summary

Definition

History and exam

Key diagnostic factors

  • skin discomfort
  • macular erythema with indistinct borders on the skin
  • disruption of cutaneous barrier
  • raised erythema with clearly demarcated margins (erysipelas)
  • risk of infection with MRSA
Full details

Other diagnostic factors

  • history of diabetes
  • constitutional prodrome
  • lymphangitis/regional lymphadenopathy
  • history of immunocompromise
  • unusual exposure (salt- or freshwater, bite)
Full details

Risk factors

  • prior episode of cellulitis
  • ulcer/wound
  • dermatosis
  • tinea pedis interdigitalis
  • lymphedema
  • venous insufficiency/chronic leg edema
  • overweight
Full details

Diagnostic investigations

1st investigations to order

  • complete blood cell count
  • purulent focus culture and molecular diagnostic procedures
Full details

Investigations to consider

  • interdigital space culture
  • skin aspiration with culture and molecular diagnostic procedures
  • blood culture
  • skin biopsy
  • plain film x-ray
  • ultrasound
  • CT scan
  • MRI
Full details

Treatment algorithm

INITIAL

any site or source: severely ill

ACUTE

immunocompetent without specific etiology

immunocompetent with specific etiology

immunocompromised

ONGOING

frequent relapses

Contributors

Authors VIEW ALL

Infectious Disease Physician

Austin Infectious Disease Consultants

Austin

TX

Disclosures

MCR declares that he has no competing interests.

Peer reviewers VIEW ALL

Ebert Professor of Medicine

Director

Division of Infectious Diseases

University of Arkansas for Medical Sciences

Little Rock

AR

Disclosures

RWB declares that he has no competing interests.

Assistant Attending

Beth Israel Medical Center

New York

NY

Disclosures

JR declares that he has no competing interests.

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