70 Cellulitis


Nonpurulent cellulitis is associated with the four cardinal signs of infection, as follows:

  • Erythema, pain, swelling, warmth

The following findings suggest severe infection:

  • Malaise, chills, fever, and toxicity
  • Lymphangitic spread (red lines streaking away from the area of infection)
  • Circumferential cellulitis
  • Pain disproportionate to examination findings

The IDSA recommends considering inpatient admission in patients with hypotension and/or the following laboratory findings :

  • Elevated creatinine level Elevated creatine phosphokinase level (2-3 times the upper limit of normal)
  • CRP level >13 mg/L (123.8 mmol/L)
  • Low serum bicarbonate level
  • Marked left shift on the CBC with differential
Hands – causing swelling at fingers or the dorsum of hand.
Cellulitis of R lower limbs is marked to allow monitoring disease progression

Consider surgical intervention in,

  • Violaceous bullae
  • Cutaneous hemorrhage
  • Skin sloughing
  • Skin anesthesia
  • Rapid progression
  • Gas in the tissue
  • Hypotension