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Cellulitis

Prevalence
Clinical features
Differential Diagnosis
Investigations
Therapy
Prevention
Prognosis
Clinical features

Most cases of cellulitis are obvious. Look for: c  
  • pain or tenderness
  • erythema
  • increased warmth
  • swelling
  • temperature 37.7°C or more
  • regional lymphadenopathy
  • systemic signs d
Look for a possible cause b  
  • a site of entry (e.g. leg ulcer, toe-web intertrigo, traumatic wound)
  • lymphoedema , leg oedema or venous insufficiency
  • obesity 
If a DVT is possible, further investigations are required e.g. ultrasound scanning.

If a Baker's cyst is possible, look for a  

  • crepitus on flexing knee 
  • history of arthritis 
  • a positive ultrasound scan  
Remember the presence of a Baker's cyst (ruptured or not) does not exclude a DVT. a  
If necrotising fasciitis is possible, ask about c  
  • history of iv drug misuse or recent illicit drug injection
  • history of hepatitis

Look for c

  • hypotension (systolic bp < 90 mmHg)
  • bullae
  • necrotic skin
  • upper extremity affected
  • crepitus 
  • sensation loss 
  • severe pain 

Think about osteomyelitis in patients with diabetes and foot ulcers and any of the following a  
  • clinical suspicion 
  • ulcer area > 2cm2 
  • bone exposed within ulcer 
  • bone palpable (by sterile probe) in ulcer  
 

Expiry date: January 2004
Levels of Evidence used in grading these guides

Authors   J   Epling , CM   Ball
Reviewer   C   Conlon
CAT Writers   J   Epling , CM   Ball