Content on this page:
Content on this page:
Clinical Presentation
Uncomplicated Cellulitis
The area involved in uncomplicated cellulitis is erythematous, warm to the touch, and swollen and is distinguished from erysipelas by non-elevated, ill-defined margins. This primarily involves subcutaneous tissues and dermis. Patients are usually asymptomatic and without comorbidity. The etiology is beta-hemolytic streptococcal etiology in 90% of infections, but S aureus is difficult to exclude especially if mixed infection occurs.
Complicated Cellulitis
Cellulitis Erysipelas_Initial Assesment 1Complicated cellulitis occurs in patients with diabetes mellitus including diabetic leg ulcers. There is the presence of comorbidities or vascular compromise (eg peripheral vascular disease, chronic venous insufficiency, morbid obesity), and if necessary, patients are hospitalized to stabilize comorbid conditions. There is also the presence of significant systemic symptoms such as acute confusion, tachycardia, tachypnea, and hypotension. The signs of potentially severe deep soft-tissue infection are violaceous bullae, cutaneous hemorrhage, skin sloughing, and gas in the tissue. Surgical debridement of the affected area may be required. The etiologies are group A streptococci, S aureus, Enterobacteriaceae and anaerobes.
Purulent Cellulitis
Purulent cellulitis is the presence of purulent exudate or drainage without a drainable abscess.
Non-purulent Cellulitis
Non-purulent cellulitis is the absence of purulent exudate or drainage without abscess.
Recurrent Cellulitis
Recurrent cellulitis is a cellulitis occurring 3-4 times/year even with pharmacological prophylaxis and control of predisposing factors.
History
The signs and symptoms include a rapidly spreading area of acute inflammation of the dermis and subcutaneous tissue which are typically unilateral and commonly seen in the lower extremities.
Cellulitis Erysipelas_Initial Assesment 2Physical Examination
The “butterfly” involvement of the face and ears (Milian’s ear sign) is suggestive of erysipelas. Lymphangitis and inflammation of the regional lymph nodes may occur. This appears as a red, swollen, and painful area of skin that is warm and tender to touch. The patient may have malaise, fever and chills. During physical examination, the location and extent of edema, erythema, warmth, and tenderness are noted so that resolution or progression may be monitored in detail. Examine for bullae, crepitus, fluctuance, necrosis, purpura and systemic signs (eg tachycardia, hypotension).