From the Guidelines
Vulvar cellulitis is characterized by physical findings of erythema, edema, warmth, tenderness, and possible purulent discharge in the vulvar region, and its treatment typically involves oral antibiotics targeting streptococci, such as penicillin, amoxicillin, or clindamycin, for a duration of 5-10 days, as recommended by the Infectious Diseases Society of America 1. The physical findings of vulvar cellulitis may include:
- Erythema (redness)
- Edema (swelling)
- Warmth
- Tenderness
- Possible purulent discharge Patients may also experience pain, discomfort, and sometimes fever or malaise if the infection is severe. The treatment of vulvar cellulitis should prioritize antibiotics that are active against streptococci, as they are the most common cause of the infection 1. Some key points to consider in the treatment of vulvar cellulitis include:
- Oral antibiotics are often sufficient for uncomplicated cases, with options including penicillin, amoxicillin, or clindamycin 1
- The duration of antibiotic treatment is typically 5-10 days, with a 5-day course being as effective as a 10-day course if clinical improvement has occurred by 5 days 1
- Supportive measures, such as warm compresses, sitz baths, and proper hygiene, can help alleviate symptoms and promote healing
- Patients should be advised to complete the full antibiotic course, even if symptoms improve quickly, and to seek immediate medical attention if symptoms worsen or if there's no improvement after 48-72 hours of treatment.
From the Research
Physical Findings of Vulvar Cellulitis
- The physical findings of vulvar cellulitis include erythema, swelling, warmth, and tenderness over the affected area 2, 3, 4, 5.
- The presentation is typically unilateral and poorly demarcated 5.
- The affected area may be painful to the touch 4.
Treatment of Vulvar Cellulitis
- Most patients with uncomplicated vulvar cellulitis can be treated as outpatients with oral antibiotics 2, 3, 4.
- The choice of antibiotic depends on the severity of the infection and the presence of risk factors for methicillin-resistant Staphylococcus aureus 2, 4.
- Dicloxacillin or cephalexin are commonly used oral antibiotics for the treatment of cellulitis when methicillin-resistant Staphylococcus aureus is not a concern 2.
- Penicillin, amoxicillin, and cephalexin are also suitable options for the treatment of non-purulent cellulitis 4.
Differential Diagnosis
- Vulvar cellulitis can be difficult to diagnose due to the presence of other dermatologic conditions that may present with similar findings, such as venous stasis dermatitis, contact dermatitis, and erythema migrans 2, 3, 4.
- A thorough history and physical examination are essential to narrow the differential diagnosis and minimize unnecessary hospitalization 5.