Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- desconforto cutâneo
- eritema macular
- ruptura da barreira cutânea
- eritema vermelho-vivo elevado com margens nitidamente demarcadas (erisipela)
- risco de infecção por Staphylococcus aureus resistente à meticilina (MRSA)
Other diagnostic factors
- história de diabetes
- pródromo de sintomas gerais
- linfangite/linfadenopatia regional
- Via de entrada identificável
- história de imunocomprometimento
- exposição incomum (água doce ou salgada, picada)
Risk factors
- diabetes
- insuficiência venosa e edema de membros inferiores crônico
- dermatose
- linfedema
- episódio prévio de celulite
- anormalidades no espaço entre os pododáctilos
- uso de substâncias por via intravenosa
- sobrepeso
Diagnostic investigations
1st investigations to order
- Hemograma completo
- cultura do foco purulento e procedimentos diagnósticos moleculares
Investigations to consider
- aspiração de pele com cultura e procedimentos diagnósticos moleculares
- hemocultura
- biópsia de pele
- radiografia simples
- ultrassonografia
- Tomografia computadorizada (TC)
- RNM
Treatment algorithm
leve
moderado
grave
falha do tratamento
recidivas frequentes
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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