Acute bacterial infection of the dermis and subcutaneous tissue, usually streptococcal or staphylococcal.
Clinical features
- • Unilateral hot, erythematous, tender, spreading area
- • Fever, malaise
- • Lymphangitis and regional lymphadenopathy
Investigations
- • Clinical diagnosis; mark the border and date it
- • Bloods and cultures if systemically unwell
- • Swab only if broken skin
- • Exclude DVT and necrotising fasciitis
Management
- • Flucloxacillin 500 mg–1 g QDS (clarithromycin if penicillin-allergic)
- • Elevate limb, treat tinea pedis and lymphoedema
- • IV therapy for Eron class III–IV or failure to improve at 48 h
Clinical pearls
- • Bilateral 'cellulitis' is almost always venous eczema or lipodermatosclerosis
- • Pain out of proportion, crepitus or rapid progression means necrotising fasciitis — surgical emergency
Related in WardRound
Educational — verify locally.
