Cellulitis

• What is cellulitis?


  Bacterial infection affecting dermis & subcutaneous tissue
• What is cellulitis often caused by?


  Streptococcus pyogenes

  Staphylococcus aureus
• Pathophys -cellulitis

  
  

  Exact pathology is poorly understood.

  Bacteria enters deep layer of dermis through break in skin → inflammatory response due to bacterial exotoxins
• What are the RFs of cellulitis in children?

  
  

  Pre-existing skin conditions (e.g. eczema)

  Immunodeficiency

  Diabetes

  Overweight/obesity

  Athlete's foot

  Breaches in skin barrier
• What are the signs & symptoms of cellulitis?


  Erythema

  Swelling

  Pain

  Poorly demarcated margins (borders of erythema are not well-defined)

  Systemic upset (fever & malaise)

  Lymphadenopathy (regional lymph nodes)

  Often evidence of a breach of skin barrier (trauma, ulcer etc.)
• What are the DDx of cellulitis?


  Erysipelas (more superficial)

  Necrotizing fasciitis

  Contact dermatitis

  Septic arthritis

  Osteomyelitis

  Impetigo
• What are the Inx for cellulitis?


  Obs

  Full Hx & examination

  Skin swabs (for culture & sensitivity)

  Bloods (FBC, U&Es, LFTs, CRP, cultures)

  Sometimes imaging to rule out abscess or osteomyelitis in severe or non-resolving cases
• What is the management of cellulitis?


  Abx (oral or IV -> depends on severity) -> flucloxacillin, clarithromycin, cephalosporins, or clindamycin

  Mark area of erythema -> to detect spread

  Analgesia

  Elevation of the affected limb

  Wound debridement (if signif necrosis or abscess formation)

  Review & adjust management based on culture results & response
• What are the possible complications of cellulitis?


  NOTE: Cellulitis is typically uncomplicated in children

  Abscess formation

  Necrotising fasciitis

  Osteomyelitis

  Sepsis

  Streptococcal toxic shock syndrome