Summary
Definition
History and exam
Key diagnostic factors
- presencia de factores de riesgo
- molestias en la piel
- eritema macular
- ruptura de la barrera cutánea
- eritema elevado de color rojo brillante con márgenes claramente delimitados (erisipela)
- riesgo de infección por Staphylococcus aureus resistente a la meticilina (SARM)
Other diagnostic factors
- antecedentes de diabetes
- pródromo general
- linfangitis/linfadenopatía regional
- Puerto de entrada identificable
- antecedentes de compromiso inmunológico
- exposición poco habitual (agua salada o dulce, mordedura)
Risk factors
- diabetes
- insuficiencia venosa y edema crónico de la pierna
- dermatosis
- linfedema
- episodio anterior de celulitis
- alteraciones en la membrana de los dedos del pie
- consumo de drogas ilícitas por vía intravenosa
- sobrepeso
Diagnostic investigations
1st investigations to order
- hemograma completo (HC)
- cultivo de foco purulento y procedimientos de diagnóstico molecular
Investigations to consider
- aspiración cutánea con cultivo y procedimientos de diagnóstico molecular
- hemocultivo
- biopsia de piel
- radiografía simple
- ultrasonido
- exploración por tomografía computarizada (TC)
- resonancia magnética (IRM)
Treatment algorithm
leve
moderado
grave
fracaso del tratamiento
pacientes con recidivas frecuentes
Contributors
Authors
Arash Mostaghimi, MD, MPA, MPH
Assistant Professor of Dermatology
Harvard Medical School
Director, Inpatient Consultation Service
Department of Dermatology
Brigham and Women’s Hospital
Boston
MA
Disclosures
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.
Acknowledgements
Dr Arash Mostaghimi would like to gratefully acknowledge Dr Matthew C. Robinson, the previous contributor to this topic.
Disclosures
MCR declares that he has no competing interests.
Peer reviewers
Robert W. Bradsher, MD
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.
Jorg Ruhe, MD, MPH
Assistant Attending
Beth Israel Medical Center
New York
NY
Disclosures
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.
References
Key articles
Raff AB, Kroshinsky D. Cellulitis: a review. JAMA. 2016 Jul 19;316(3):325-37. Abstract
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.Full text Abstract
American College of Radiology. ACR appropriateness criteria: suspected osteomyelitis, septic arthritis, or soft tissue infection (excluding spine and diabetic foot). 2022 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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