From the Guidelines
Cellulitis is characterized by a red, swollen, painful area of skin that is warm and tender to touch, often with poorly defined borders, and may be accompanied by systemic symptoms such as fever, chills, and fatigue. The infection typically develops when bacteria, usually streptococcus or staphylococcus, enter through breaks in the skin such as cuts, scrapes, or dermatitis 1. The affected area may develop blisters, skin dimpling, or areas that look like an orange peel texture, and in more severe cases, red streaks may extend from the infected area, indicating the infection is spreading through the lymphatic system 1.
Clinical Manifestations
- Redness and swelling of the affected area
- Warmth and tenderness to touch
- Poorly defined borders
- Blisters, skin dimpling, or orange peel texture
- Systemic symptoms such as fever, chills, and fatigue
- Red streaks extending from the infected area, indicating lymphatic spread
Diagnosis and Management
The diagnosis of cellulitis is primarily clinical, and treatment should be initiated promptly with antibiotics active against streptococci, such as penicillin, amoxicillin, or cephalexin 1. The recommended duration of antimicrobial therapy is 5 days, but treatment should be extended if the infection has not improved within this time period 1. It is also essential to identify and treat predisposing conditions, such as edema, obesity, eczema, venous insufficiency, and toe web abnormalities, to prevent recurrent episodes of cellulitis 1.
Prevention of Recurrent Episodes
In patients with recurrent episodes of cellulitis, administration of prophylactic antibiotics, such as oral penicillin or erythromycin, should be considered to reduce the frequency of episodes 1. Additionally, addressing predisposing factors, such as edema, obesity, and eczema, is crucial in preventing recurrent episodes of cellulitis 1.
From the Research
Clinical Manifestations of Cellulitis
The clinical manifestations of cellulitis include:
- Erythema (redness of the skin) 2, 3, 4, 5
- Swelling over the affected area 2, 3, 4, 5
- Warmth over the affected area 2, 3, 4
- Tenderness or pain over the affected area 2, 3, 4, 5
- Expanding erythema (spreading redness) 3
Common Mimics of Cellulitis
Cellulitis can be mimicked by other dermatologic diseases, including:
- Venous stasis dermatitis 2
- Contact dermatitis 2
- Deep vein thrombosis 2
- Panniculitis 2
- Erysipelas (a subtype of cellulitis) 5
Diagnosis and Treatment
Diagnosis of cellulitis is based primarily on history and physical examination 3, 4. Treatment of uncomplicated cellulitis should be directed against Streptococcus and methicillin-sensitive S. aureus 3. The most common causative bacteria of cellulitis are β-hemolytic Streptococcus and Staphylococcus aureus 3. Oral antibiotics such as dicloxacillin or cephalexin are commonly used to treat cellulitis 2, 6.