2. DEFINITION An acute, diffuse, spreading infection of theskin,
involving the deeper layers of the skin andthe subcutaneous tissue.
Periorbital cellulitis is a special form of cellulitisthat usually
occurs in children. In this form ofcellulitis, unilateral swelling
and redness of theeyelid and orbital area, as well as fever
andmalaise are usually present. 3. Serious infections of deeper
skin structures 4. CAUSES Staphylococcus Streptococcus Group A H.
Influenzae (periorbital cellulitis) pasteurella multocida Facial
cellulitis in children < 3 years oldHemophilus influenzae or
Streptococcuspneumoniae 5. PREDISPOSING RISK FACTORS Local trauma
(e.g., lacerations, insect bites,wounds, shaving) Skin infections
such as impetigo, scabies, furuncle,tinea pedis Underlying skin
ulcer Fragile skin Immunocompromised host Diabetes mellitus
Inflammation (e.g., eczema) Edema secondary to venous insufficiency
orlymphedema 6. TYPICAL FINDINGS OFCELLULITISHistory Presence of
predisposing risk factor Area increasingly red, warm to touch,
painful Area around skin lesion also tender but painlocalized Edema
Mild systemic symptoms low-grade fever, chills,malaise, and
headache may be present 7. Physical Assessment Local symptoms:
Erythema and edema of area Warm to touch, Possibly fluctuant
(tense, firm to palpation) May resemble peau dorange Advancing edge
of lesion diffuse, not sharplydemarcated Small amount of purulent
discharge may bepresent Unilateral 8. Systemic indications:
Increased temperature Increased pulse Lymphadenopathy of regional
lymph nodes and /or lymphangitis 9. Diagnostic Tests Swab any wound
discharge for culture andsensitivity 10. MANAGEMENT
ANDINTERVENTIONS Do not underestimate cellulitis. It can spread
veryquickly and may progress rapidly to necrotizingfasciitis. It
should be treated aggressively andmonitored on an ongoing basis 11.
Goals of Treatment for MildCellulitis Resolve infection Identify
formation of abscess Check tetanus prophylaxis 12.
Non-pharmacologicInterventions Apply warm or, if more comfortable,
cool salinecompresses to affected areas qid for 15 minutes. Mark
border of erythema with pen to monitorspread. Elevate, rest and
gently splint the affected limb. 13. Pharmacologic
InterventionsPain management: acetaminophen 10-15mg/kg per day po
q4-6hours.Do not exceed 75mg/kg per 24 hours Oral antibiotics if no
known MRSA or non-purulentcellulitis:cephalexin 40mg/kg per day po
divided qid for 7-10days uUsually first choice due to taste),
orcloxacillin 40mg/kg per day po divided qid for 7-10days Patients
with penicillin allergy:erythromycin 40 mg/kg/day divided bid for
7-10days Patients with known community acquired MRSA orpurulent
cellulitis:trimethoprim-sulfamethoxazole 8-12 mg / kg per daypo bid
for 7 days (dosing is based on trimethoprim) 14. Pregnant or
Breastfeeding Women Cephalexin, cloxacillin, erythromycin
andacetaminophen may be used as listed above.
Trimethoprim-sulfamethoxazole is contraindicated
