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CELLULITIS
DEFINITION
An acute, diffuse, spreading infection of the
skin, involving the deeper layers of the skin and
the subcutaneous tissue.
Periorbital cellulitis is a special form of cellulitis
that usually occurs in children. In this form of
cellulitis, unilateral swelling and redness of the
eyelid and orbital area, as well as fever and
malaise are usually present.
Serious infections of deeper skin structures
CAUSES
Staphylococcus
Streptococcus Group A β
H. Influenzae (periorbital cellulitis)
pasteurella multocida
Facial cellulitis in children < 3 years old
Hemophilus influenzae or Streptococcus
pneumoniae
PREDISPOSING RISK FACTORS
Local trauma (e.g., lacerations, insect bites,
wounds, shaving)
Skin infections such as impetigo, scabies, furuncle,
tinea pedis
Underlying skin ulcer
Fragile skin
Immunocompromised host
Diabetes mellitus
Inflammation (e.g., eczema)
Edema secondary to venous insufficiency or
lymphedema
TYPICAL FINDINGS OF
CELLULITIS
History
Presence of predisposing risk factor
Area increasingly red, warm to touch, painful
Area around skin lesion also tender but pain
localized
Edema
Mild systemic symptoms – low-grade fever, chills,
malaise, and headache may be present
Physical Assessment
Local symptoms:
Erythema and edema of area
Warm to touch,
Possibly fluctuant (tense, firm to palpation)
May resemble peau d’orange
Advancing edge of lesion diffuse, not sharply
demarcated
Small amount of purulent discharge may be
present
Unilateral
Systemic indications:
Increased temperature
Increased pulse
Lymphadenopathy of regional lymph nodes and /
or lymphangitis
Diagnostic Tests
Swab any wound discharge for culture and
sensitivity
MANAGEMENT AND
INTERVENTIONS
Do not underestimate cellulitis. It can spread very
quickly and may progress rapidly to necrotizing
fasciitis. It should be treated aggressively and
monitored on an ongoing basis
Goals of Treatment for Mild
Cellulitis
Resolve infection
Identify formation of abscess
Check tetanus prophylaxis
Non-pharmacologic
Interventions
Apply warm or, if more comfortable, cool saline
compresses to affected areas qid for 15 minutes.
Mark border of erythema with pen to monitor
spread.
Elevate, rest and gently splint the affected limb.
Pharmacologic Interventions
Pain management:
acetaminophen 10-15mg/kg per day po q4-6hours.
Do not exceed 75mg/kg per 24 hours
Oral antibiotics if no known MRSA or non-purulent
cellulitis:
cephalexin 40mg/kg per day po divided qid for 7-10
days uUsually first choice due to taste), or
cloxacillin 40mg/kg per day po divided qid for 7-10
days
Patients with penicillin allergy:
erythromycin 40 mg/kg/day divided bid for 7-10
days
Patients with known community acquired MRSA or
purulent cellulitis:
trimethoprim-sulfamethoxazole 8-12 mg / kg per day
po bid for 7 days (dosing is based on trimethoprim)
Pregnant or Breastfeeding Women
Cephalexin, cloxacillin, erythromycin and
acetaminophen may be used as listed above.
Trimethoprim-sulfamethoxazole is contraindicated

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cellulitis

  • 2. DEFINITION An acute, diffuse, spreading infection of the skin, involving the deeper layers of the skin and the subcutaneous tissue. Periorbital cellulitis is a special form of cellulitis that usually occurs in children. In this form of cellulitis, unilateral swelling and redness of the eyelid and orbital area, as well as fever and malaise are usually present.
  • 3. Serious infections of deeper skin structures
  • 4. CAUSES Staphylococcus Streptococcus Group A β H. Influenzae (periorbital cellulitis) pasteurella multocida Facial cellulitis in children < 3 years old Hemophilus influenzae or Streptococcus pneumoniae
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  • 6. PREDISPOSING RISK FACTORS Local trauma (e.g., lacerations, insect bites, wounds, shaving) Skin infections such as impetigo, scabies, furuncle, tinea pedis Underlying skin ulcer Fragile skin Immunocompromised host Diabetes mellitus Inflammation (e.g., eczema) Edema secondary to venous insufficiency or lymphedema
  • 7. TYPICAL FINDINGS OF CELLULITIS History Presence of predisposing risk factor Area increasingly red, warm to touch, painful Area around skin lesion also tender but pain localized Edema Mild systemic symptoms – low-grade fever, chills, malaise, and headache may be present
  • 8. Physical Assessment Local symptoms: Erythema and edema of area Warm to touch, Possibly fluctuant (tense, firm to palpation) May resemble peau d’orange Advancing edge of lesion diffuse, not sharply demarcated Small amount of purulent discharge may be present Unilateral
  • 9. Systemic indications: Increased temperature Increased pulse Lymphadenopathy of regional lymph nodes and / or lymphangitis
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  • 11. Diagnostic Tests Swab any wound discharge for culture and sensitivity
  • 12. MANAGEMENT AND INTERVENTIONS Do not underestimate cellulitis. It can spread very quickly and may progress rapidly to necrotizing fasciitis. It should be treated aggressively and monitored on an ongoing basis
  • 13. Goals of Treatment for Mild Cellulitis Resolve infection Identify formation of abscess Check tetanus prophylaxis
  • 14. Non-pharmacologic Interventions Apply warm or, if more comfortable, cool saline compresses to affected areas qid for 15 minutes. Mark border of erythema with pen to monitor spread. Elevate, rest and gently splint the affected limb.
  • 15. Pharmacologic Interventions Pain management: acetaminophen 10-15mg/kg per day po q4-6hours. Do not exceed 75mg/kg per 24 hours Oral antibiotics if no known MRSA or non-purulent cellulitis: cephalexin 40mg/kg per day po divided qid for 7-10 days uUsually first choice due to taste), or cloxacillin 40mg/kg per day po divided qid for 7-10 days Patients with penicillin allergy: erythromycin 40 mg/kg/day divided bid for 7-10 days Patients with known community acquired MRSA or purulent cellulitis: trimethoprim-sulfamethoxazole 8-12 mg / kg per day po bid for 7 days (dosing is based on trimethoprim)
  • 16. Pregnant or Breastfeeding Women Cephalexin, cloxacillin, erythromycin and acetaminophen may be used as listed above. Trimethoprim-sulfamethoxazole is contraindicated