Cellulitis

• Cellulitis is an infection of the dermis and subcutaneous tissue
• When a patient presents with cellulitis, look for a breach in the skin barrier and a point of entry for the bacteria. 
• Skin changes in cellulitis include:

  • Erythema (red discolouration)
  • Warm or hot to touch
  • Tense
  • Thickened
  • Oedematous
  • Bullae (fluid-filled blisters)
  • Dimpled skin - peau d'orange
  • Purpura - petechiae, ecchymoses
  • A golden-yellow crust indicates a Staphylococcus aureus infection
• Patients may be systemically unwell, including having sepsis.
• Staphylococcus aureus is the most common cause

  Followed by Streptococcus pyogenes
• The Eron classification assesses the severity of cellulitis
• Flucloxacillin is the usual first-line antibiotic for cellulitis, either oral or intravenous. 
• Vancomycin is usually used to treat MRSA
• Inform patients to seek medical help if symptoms worsen rapidly or significantly at any time, or do not start to improve within 2-3 days
• Antibiotics:

  • First line = flucloxacillin for 5 days
  • Second line = clarithromycin or doxycycline
  • If lymphoedema longer course needed
• The first sign is often feeling unwell - fever, chills due to bacteraemia

  May be associated with lymphangitis (inflammation of lymphatic vessels) and lymphadenitis (inflammation of lymph nodes)
• When to admit:

  • Systemic unwell
  • Extensive area
  • Under 1 year old or frail
  • Immunocompromised
  • Facial
  • Orbital/peri-orbital
  • Querying necrotizing fasciitis