Guidelines
Cellulitis, Acute

Cellulitis, Acute

Clinical/Diagnostic Considerations

Clinical features are pain, swelling, erythema and warmth. Cellulitis can be non-purulent or purulent (abscesses). If patient is very ill or has pain out of proportion to appearance, consider necrotizing fasciitis.

Neonatal mastitis, omphalitis, dacryocystitis are usually due to Staphylococcus aureus

  • Non-purulent cellulitis usually has a rapid onset (less than one day),usually legs, occ. face; most common cause is Streptococcus pyogenes (GAS)
  • Purulent cellulitis is characterized by skin abscesses/ purulent discharge;~80%-90% S. aureus.  Send cultures.
  • Soil or water contamination, other bacteria such as Aeromonas (fast onset, fasciitis-like),Vibrio (seawater), other Gram negatives; take blood, cultures, tissue and fluid cultures; verify immunization status (i.e. tetanus).

Erythema migrans (Lyme Disease) lesions are usually large (>5cm), and not tender (though can be mildly pruritic).

Herpes (vesicles or shallow ulcers). 

Insect bites or urticaria which are very pruritic, not tender.