From the Guidelines
When describing an infected area of skin abscess or cellulitis during a physical examination, focus on documenting the key characteristics systematically, including location, size, color, warmth, swelling, induration, borders, tenderness, fluctuance, and drainage, as recommended by the 2014 update by the Infectious Diseases Society of America 1. Begin by noting the exact anatomical location and size of the affected area, measuring the dimensions in centimeters. Document the color, which typically ranges from pink to deep red or purple in cellulitis, and may appear more fluctuant or pointing with an abscess. Record the presence of warmth by comparing with surrounding skin through palpation. Note any swelling, induration (hardness), and clearly define the borders, as cellulitis often has poorly demarcated edges while abscesses may have more distinct boundaries. Document tenderness on palpation, using a pain scale if appropriate, and note any fluctuance (fluid sensation) which suggests abscess formation. Look for and describe any drainage, including color, consistency, and odor. Check for associated findings such as lymphangitis (red streaking), regional lymphadenopathy, systemic symptoms like fever, and measure the extent of any surrounding erythema by marking the borders. These detailed observations help distinguish between cellulitis (diffuse skin infection) and abscess (localized collection of pus), guiding appropriate treatment decisions and providing a baseline for monitoring the infection's progression or resolution over time, as outlined in the 2018 WSES/SIS-E consensus conference recommendations 1. Key characteristics to document include:
- Location and size of the affected area
- Color and warmth of the skin
- Presence of swelling, induration, and distinct borders
- Tenderness and fluctuance
- Drainage, including color, consistency, and odor
- Associated findings such as lymphangitis and regional lymphadenopathy
- Systemic symptoms like fever By following this systematic approach, clinicians can provide accurate and detailed descriptions of infected areas, ultimately guiding effective treatment and management of skin abscesses and cellulitis, as supported by the practice guidelines for the diagnosis and management of skin and soft tissue infections 1.
From the Research
Physical Examination of Infected Area of Skin Abscess Cellulitis
To describe an infected area of skin abscess cellulitis in a physical examination, consider the following characteristics:
- The infected area typically presents with poorly demarcated unilateral erythema, which is redness of the skin due to increased blood flow in the area 2.
- The area is usually warm to the touch, indicating increased blood flow and inflammation 3, 2.
- Tenderness and pain are common symptoms, making the area sensitive to pressure or touch 3, 2.
- Swelling is also a typical presentation, resulting from the accumulation of fluid and inflammatory cells in the affected tissue 3.
Differentiation from Other Conditions
It is essential to differentiate cellulitis from other conditions that may present with similar symptoms, such as:
- Venous stasis dermatitis
- Contact dermatitis
- Eczema
- Lymphedema
- Erythema migrans 3 A thorough history and clinical examination can help narrow the differential diagnosis and minimize unnecessary hospitalization 2.
Diagnostic Challenges
Cellulitis can be challenging to diagnose due to the lack of a gold standard diagnostic test 3, 2. Microbiological diagnosis is often unobtainable due to poor sensitivity of culture specimens 3. Therefore, a holistic patient assessment, skin assessment, and thorough clinical history are crucial in the diagnosis of cellulitis 4. Point-of-care ultrasound can be a useful tool in unclear cases 5.