Last reviewed: 30 Oct 2023
Last updated: 05 Aug 2020
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
More key diagnostic factors
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)
More risk factors
Diagnostic investigations
1st investigations to order
- complete blood count and differential
- serum electrolytes
- serum BUN and creatinine
- serum CRP
- serum creatine kinase (CK)
- serum lactate
- blood and tissue cultures
- Gram stain
- arterial blood gas
- radiography, CT/MRI, ultrasound
- surgical exploration
More 1st investigations to order
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
Kevin L. Steiner, MD, PhD, DTM&H
Fellow
Division of Infectious Diseases and International Health
University of Virginia
Charlottesville
VA
Disclosures
KLS declares that he has no competing interests.
William A. Petri, Jr, MD, PhD, FACP

Wade Hampton Frost Professor of Epidemiology
Professor of Medicine
Microbiology and Pathology
Division of Infectious Diseases and International Health
University of Virginia
Charlottesville
VA
Disclosures
WAP declares that he has no competing interests.
Peer reviewers
Chris Huston, MD
Assistant Professor of Medicine
Division of Infectious Diseases
University of Vermont
Burlington
VT
Disclosures
CH 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
- 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
More GuidelinesLog in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer