Cellulitis

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Cellulitis

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Chapter 8 Skin & Soft Tissue Inﬂammation & Infections SIGNS & SYMPTOMS ▪ Papules, pustules, painful nodules (cysts) on face, neck, chest, back ▪ Closed comedones ▪ Erythema DIAGNOSIS ▪ In case of comedonal acne, use azelaic acid, salicylic acid as anti-inﬂammatory, antibacterial, antiproliferative agent Mild to moderate ▪ Benzoyl peroxide, retinoid ▪ Add topical antibiotic (clindamycin) for synergistic effect with benzoyl peroxide Severe ▪ Oral isotretinoin decreases sebum production, bacterial proliferation, inﬂammation ▪ Avoid using tetracycline due to sun sensitivity OTHER DIAGNOSTICS ▪ Clinical presentation TREATMENT OTHER INTERVENTIONS MEDICATIONS ▪ Target sebum production, inﬂammation, bacterial/follicular proliferation Mild ▪ Benzoyl peroxide treats Propionibacterium acnes ▪ Add topical retinoids to prevent follicular proliferation ▪ Clean skin with gentle agents ▪ Comedones extraction ▪ Pigmentation ▫ Topical retinoid, azelaic acid, chemical peels ▫ Photodynamic treatment with lasers (removes superﬁcial layers of skin) ▫ Dermabrasion (treatment of scars; may irritate skin) CELLULITIS osms.it/cellulitis PATHOLOGY & CAUSES ▪ Non-necrotizing inﬂammation of dermis, subcutaneous tissue, typically caused by streptococci (S. aureus, S. pyogenes); usually unilateral ▪ Skin breach: trauma; dry, ﬁssuring skin; ulcers → bacteria invade skin, subcutaneous tissue ▪ Common locations: face, legs; may affect arms ▪ Other locations: causes vary ▫ Orbital cellulitis: originates from trauma, sinuses, hematogenous spread ▫ Abdominal wall cellulitis: morbid obesity causes bacteria to enter skin sores ▫ Buccal cellulitis: spread from tooth infection ▫ Perianal cellulitis: affects all demographics TYPES ▪ Purulent ▫ Furuncles (inﬂamed follicles), carbuncles (accumulation of furuncles), abscesses, cysts ▪ Non-purulent ▫ Superﬁcial cellulitis, erysipelas OSMOSIS.ORG 45

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Cellulitis

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A 36-year-old man presents to the emergency department for evaluation of a rash on the right forearm. The patient was recently admitted to the hospital for pain-control in the setting of nephrolithiasis. He recalls, “After I left, I was feeling fine, then the next day my arm started hurting, and I noticed a red rash near the site where I had my IV.” He is otherwise healthy and does not take any medications daily. Temperature is 38.0°C (100.4°F), pulse is 110/min, respirations are 14/min, and blood pressure is 119/77 mmHg. Physical examination demonstrates a well demarcated erythematous, warm, and painful rash over the anterior aspect of the right forearm without fluctuance. Infection with which of the following organisms is most likely responsible for this patient’s cutaneous findings?

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