Cellulitis

Ayşe Gülden BEKGÖZ
University of Health Sciences Faculty of Medicine, Gaziler Physical Therapy and Rehabilitation Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Türkiye

Bekgöz AG. Cellulitis. In: Oğuztürk H, Görmeli Kurt N, eds. Dermatologic Emergencies. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.21-30.

ABSTRACT

Cellulitis is an acute bacterial infection that affects the deep dermis and subcutaneous tis- sues. It is a common disease that causes significant health care costs, can be difficult to distinguish clinically from other diseases affecting the skin, and has no gold standard for diagnosis. While a comprehensive history and clinical examination aid in diagnosis, it usually does not require evaluation with laboratory and imaging studies. Although cellulitis is most commonly caused by group A β- hemolytic streptococcus (Streptococcus pyogenes) infection, the rate of pathogen isolation is low and treatment is often initiated empirically. The most important risk factor for the development of cellulitis is lymphedema, and treatment should also include underlying conditions and patient education.

Keywords: Cellulitis; erysipelas; emergency medical services; S. pyogenes; lymphedema

Referanslar

  1. Long B, Gottlieb M. Diagnosis and Management of Cellulitis and Abscess in the Emergency Department Setting: An Evidence-Based Review. J Emerg Med. 2022;62(1):16-27. [Crossref]  [PubMed]
  2. Hersh AL, Chambers HF, Maselli JH, Gonzales R. National trends in ambulatory visits and antibiotic prescribing for skin and soft-tissue infections. Arch Intern Med. 2008;168(14):1585-91. [Crossref]  [PubMed]
  3. Raff AB, Kroshinsky D. Cellulitis: A Review. JAMA. 2016;316(3):325-37. [Crossref]  [PubMed]
  4. Bystritsky RJ. Cellulitis. Infect Dis Clin North Am. 2021;35(1):49-60. [Crossref]  [PubMed]
  5. Stevens DL, Bisno AL, Chambers HF, Everett ED, Dellinger P, Goldstein EJ, Gorbach SL, Hirschmann JV, Kaplan EL, Montoya JG, Wade JC; Infectious Diseases Society of America. Practice guidelines for the diagnosis and management of skin and soft-tissue infections. Clin Infect Dis. 2005;41(10):1373- 406. Erratum in: Clin Infect Dis. 2005;41(12):1830. Erratum in: Clin Infect Dis. 2006;42(8):1219. [Crossref]  [PubMed]
  6. Goettsch WG, Bouwes Bavinck JN, Herings RM. Burden of illness of bacterial cellulitis and erysipelas of the leg in the Netherlands. J Eur Acad Dermatol Venereol. 2006;20(7):834-9. [Crossref]  [PubMed]
  7. Marcelin JR, Challener DW, Tan EM, Lahr BD, Baddour LM. Incidence and Effects of Seasonality on Nonpurulent Lower Extremity Cellulitis After the Emergence of Community-Acquired Methicillin-Resistant Staphylococcus aureus. Mayo Clin Proc. 2017;92(8):1227-33. [Crossref]  [PubMed]  [PMC]
  8. McNamara DR, Tleyjeh IM, Berbari EF, Lahr BD, Martinez JW, Mirzoyev SA, et al. Incidence of lower-extremity cellulitis: a population-based study in Olmsted county, Minnesota. Mayo Clin Proc. 2007;82(7):817-21. [Crossref]  [PubMed]
  9. Morgan E, Hohmann S, Ridgway JP, Daum RS, David MZ. Decreasing Incidence of Skin and Soft-tissue Infections in 86 US Emergency Departments, 2009-2014. Clin Infect Dis. 2019;68(3):453-59. [Crossref]  [PubMed]  [PMC]
  10. Quirke M, Ayoub F, McCabe A, Boland F, Smith B, O'Sullivan R, et al. Risk factors for nonpurulent leg cellulitis: a systematic review and meta-analysis. Br J Dermatol. 2017;177(2):382-94. [Crossref]  [PubMed]
  11. Lopez M, Roberson ML, Strassle PD, Ogunleye A. Epidemiology of Lymphedema-related admissions in the United States: 2012-2017. Surg Oncol. 2020;35:249-53. [Crossref]  [PubMed]
  12. Richmond JM, Harris JE. Immunology and skin in health and disease. Cold Spring Harb Perspect Med. 2014;4(12):a015339. [Crossref]  [PubMed]  [PMC]
  13. Chira S, Miller LG. Staphylococcus aureus is the most common identified cause of cellulitis: a systematic review. Epidemiol Infect. 2010;138(3):313-7. [Crossref]  [PubMed]
  14. Gunderson CG, Martinello RA. A systematic review of bacteremias in cellulitis and erysipelas. J Infect. 2012;64(2):148-55. [Crossref]  [PubMed]
  15. Jeng A, Beheshti M, Li J, Nathan R. The role of beta-hemolytic streptococci in causing diffuse, nonculturable cellulitis: a prospective investigation. Medicine. 2010;89(4):217-26. [Crossref]  [PubMed]
  16. Pallin DJ, Binder WD, Allen MB, Lederman M, Parmar S, Filbin MR, et al. Clinical trial: comparative effectiveness of cephalexin plus trimethoprim-sulfamethoxazole versus cephalexin alone for treatment of uncomplicated cellulitis: a randomized controlled trial. Clin Infect Dis. 2013;56(12):1754-62. [Crossref]  [PubMed]
  17. Moran GJ, Krishnadasan A, Gorwitz RJ, Fosheim GE, McDougal LK, Carey RB, et al.; EMERGEncy ID Net Study Group. Methicillin-resistant S. aureus infections among patients in the emergency department. N Engl J Med. 2006;355(7):666-74. [Crossref]  [PubMed]
  18. Daum RS. Clinical practice. Skin and soft-tissue infections caused by methicillin-resistant Staphylococcus aureus. N Engl J Med. 2007;357(4):380-90. [Crossref]  [PubMed]
  19. Spelman D, Baddour LM. Cellulitis and skin abscess: Epidemiology, microbiology, clinical manifestations, and diagnosis. UpToDate. 2024. Accessed August 1, 2024. [Link]
  20. Boettler MA, Kaffenberger BH, Chung CG. Cellulitis: A Review of Current Practice Guidelines and Differentiation from Pseudocellulitis. Am J Clin Dermatol. 2022;23(2):153-65. [Crossref]  [PubMed]
  21. Collazos J, de la Fuente B, de la Fuente J, García A, Gómez H, Menéndez C, et al. Factors associated with sepsis development in 606 Spanish adult patients with cellulitis. BMC Infect Dis. 2020;20(1):211. [Crossref]  [PubMed]  [PMC]
  22. Drinka P, Bonham P, Crnich CJ. Swab culture of purulent skin infection to detect infection or colonization with antibiotic-resistant bacteria. J Am Med Dir Assoc. 2012;13(1):75-9. [Crossref]  [PubMed]
  23. Hayeri MR, Ziai P, Shehata ML, Teytelboym OM, Huang BK. Soft-Tissue Infections and Their Imaging Mimics: From Cellulitis to Necrotizing Fasciitis. Radiographics. 2016;36(6):1888-910. [Crossref]  [PubMed]
  24. Zacharias N, Velmahos GC, Salama A, Alam HB, de Moya M, King DR, et al. Diagnosis of necrotizing soft tissue infections by computed tomography. Arch Surg. 2010;145(5):452-5. [Crossref]  [PubMed]
  25. Miller LG, Daum RS, Creech CB, Young D, Downing MD, Eells SJ, et al. Clindamycin versus trimethoprim-sulfamethoxazole for uncomplicated skin infections. N Engl J Med. 2015;372(12):1093-103. [Crossref]  [PubMed]  [PMC]
  26. Williams OM, Brindle R. Antibiotic route and duration of therapy for cellulitis: data extracted from a multi-center clinical trial. Int J Antimicrob Agents. 2020;56(3):106076. [Crossref]  [PubMed]
  27. Cross ELA, Jordan H, Godfrey R, Onakpoya IJ, Shears A, Fidler K, et al. Route and duration of antibiotic therapy in acute cellulitis: A systematic review and meta-analysis of the effectiveness and harms of antibiotic treatment. J Infect. 2020;81(4):521-31. [Crossref]  [PubMed]
  28. Collazos J, de la Fuente B, García A, Gómez H, Menéndez C, Enríquez H, et al. Cellulitis in adult patients: A large, multicenter, observational, prospective study of 606 episodes and analysis of the factors related to the response to treatment. PLoS One. 2018;13(9):e0204036. [Crossref]  [PubMed]  [PMC]
  29. Karppelin M, Siljander T, Vuopio-Varkila J, Kere J, Huhtala H, Vuento R, et al. Factors predisposing to acute and recurrent bacterial non-necrotizing cellulitis in hospitalized patients: a prospective case-control study. Clin Microbiol Infect. 2010;16(6):729-34. [Crossref]  [PubMed]
  30. Soo JK, Bicanic TA, Heenan S, Mortimer PS. Lymphatic abnormalities demonstrated by lymphoscintigraphy after lower limb cellulitis. Br J Dermatol. 2008;158(6):1350-3. [Crossref]  [PubMed]
  31. Grada AA, Phillips TJ. Lymphedema: Diagnostic workup and management. J Am Acad Dermatol. 2017;77(6):995-1006. [Crossref]  [PubMed]
  32. Mihara M, Hara H, Furniss D, Narushima M, Iida T, Kikuchi K, et al. Lymphaticovenular anastomosis to prevent cellulitis associated with lymphoedema. Br J Surg. 2014;101(11):1391-6. [Crossref]  [PubMed]
  33. Dalal A, Eskin-Schwartz M, Mimouni D, Ray S, Days W, Hodak E, et al. Interventions for the prevention of recurrent erysipelas and cellulitis. Cochrane Database Syst Rev. 2017;6(6):CD009758. [Crossref]  [PubMed]
  34. Mason JM, Thomas KS, Crook AM, Foster KA, Chalmers JR, Nunn AJ, et al. Prophylactic antibiotics to prevent cellulitis of the leg: economic analysis of the PATCH I & II trials. PLoS One. 2014;9(2):e82694. [Crossref]  [PubMed]  [PMC]
  35. Dall L, Peterson S, Simmons T, Dall A. Rapid resolution of cellulitis in patients managed with combination antibiotic and anti-inflammatory therapy. Cutis. 2005;75(3):177-80. [PubMed]
  36. Davis JS, Mackrow C, Binks P, Fletcher W, Dettwiller P, Marshall C, et al. A double-blind randomized controlled trial of ibuprofen compared to placebo for uncomplicated cellulitis of the upper or lower limb. Clin Microbiol Infect. 2017;23(4):242-6. [Crossref]  [PubMed]
  37. Bergkvist PI, Sjöbeck K. Antibiotic and prednisolone therapy of erysipelas: a randomized, double blind, placebo-controlled study. Scand J Infect Dis. 1997;29(4):377-82. [Crossref]  [PubMed]
  38. Bergkvist PI, Sjöbeck K. Relapse of erysipelas following treatment with prednisolone or placebo in addition to antibiotics: a 1-year follow-up. Scand J Infect Dis. 1998;30(2):206-7. [Crossref]  [PubMed]