← Diagnosis and Management Guides
Cellulitis
Key considerations: Necrotizing fasciitis, Sepsis, DVT
Cannot miss
- Necrotizing fasciitis
- Sepsis
- DVT
- Osteomyelitis
Likely diagnoses
- Non-purulent cellulitis
- Purulent cellulitis/abscess
- Stasis dermatitis
- Contact dermatitis
Red flags
- Crepitus
- Pain out of proportion
- Rapid spread
- Hemodynamic instability
- Purple/necrotic skin
Workup
- history: Onset, trauma, animal/insect bite, prior episodes, immunocompromised; exam: Demarcate borders with marker, assess for fluctuance, crepitus; labs: CBC, BMP, blood cultures if systemic; CRP/ESR; imaging: Ultrasound for abscess; CT/MRI if necrotizing fasciitis suspected; bedside: LRINEC score if necrotizing fasciitis concern
Management
- immediate: IV antibiotics if systemic: vancomycin + piperacillin-tazobactam; general: Non-purulent: cephalexin or dicloxacillin; Purulent/MRSA risk: TMP-SMX or doxycycline; I&D for abscess
Disposition
- admit: Systemic toxicity, facial cellulitis, failed outpatient treatment; discharge: Mild cellulitis with close follow-up in 48-72 hours; consults: Surgery STAT if necrotizing fasciitis suspected
Clinical pearls
- Necrotizing fasciitis: pain out of proportion, crepitus, rapidly advancing, and systemically ill — surgery should NOT be delayed for imaging
Source and review
- IDSA SSTI Guidelines 2014. Last reviewed: 2024-11-01