x
x

CELLULITIS

Introduction

Cellulitis is a bacterial infection of the skin and subcutaneous tissues. The most common bacteria involved include Staphylococcus and Streptococcus. In recent years, community-acquired methicillin-resistant Staphylococcus aureus (ca-MRSA) has become a more prevalent cause. Cellulitis needs to be treated in a timely manner, especially for high-risk patients, to prevent abscess formation, which may spread the infection to other parts of the body.

Related Anatomy

  • Skin
  • Subcutaneous tissue

Incidence and Related Conditions

  • ca-MRSA infections have become more common since 2008

Differential Diagnosis

  • Herpetic whitlow
  • Paronychia
  • Felon finger
  • Necrotizing fasciitis
ICD-10 Codes

  • CELLULITIS

    Diagnostic Guide Name

    CELLULITIS

    ICD 10 Diagnosis, Single Code, Left Code, Right Code and Bilateral Code

    DIAGNOSISSINGLE CODE ONLYLEFTRIGHTBILATERAL (If Available)
    CELLULITIS - FINGER/THUMB L03.012L03.011 
    CELLULITIS - UPPER LIMB (HAND, WRIST, FOREARM) L03.114L03.113 

    ICD-10 Reference

    Reproduced from the International statistical classification of diseases and related health problems, 10th revision, Fifth edition, 2016. Geneva, World Health Organization, 2016 https://apps.who.int/iris/handle/10665/246208

Clinical Presentation Photos and Related Diagrams
  • Cellulitis Left Index Finger
    Cellulitis Left Index Finger
  • Cellulitis Left Volar Wrist with abscess
    Cellulitis Left Volar Wrist with abscess
  • Cellulitis right hand starting to resolve after I & D of associated abscess
    Cellulitis right hand starting to resolve after I & D of associated abscess
Symptoms
Tenderness and red areas in the skin
Sometimes involves breaks in the skin due to a splinter, insect bite or small cut
MRSA can produce skin breaks with a spider-bite appearance
Typical History

The patient usually presents with swelling and redness of the hand. Farmers, scuba divers and people who work with animals are susceptible to cellulitis. Children, especially those who play contact sports, may be at higher risk for MRSA infections of the hand. Extra care should be taken with patients who have diabetes, immune deficiencies or abuse intravenous drugs.

Positive Tests, Exams or Signs
Work-up Options
Images (X-Ray, MRI, etc.)
  • Cellulitis secondary to cat bite. Note soft tissue swelling (arrows). Bones are normal.
    Cellulitis secondary to cat bite. Note soft tissue swelling (arrows). Bones are normal.
Treatment Options
Conservative
  • Rest the affected areas
  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Oral antibiotics: trimethoprim-sulfamethoxazole can be used for MRSA infections
  • Intravenous (IV) antibiotics: use vancomycin or clindamycin if hospitalized
    • Clindamycin should be avoided if patient history includes drug use
Operative
  • In rare cases for MRSA infections, use surgical debridement to excise the infected tissue
Complications
  • Abscess, bacteremia and septicemia
Outcomes
  • Results are usually positive if the cellulitis is treated quickly with appropriate antibiotics
Key Educational Points
  • It is possible to be a carrier of CA-MRSA, but not to show any symptoms.
  • Povidone-iodine soaks are not useful after operative treatment.
  • If left untreated, cellulitis may lead to necrotizing fasciitis. 
References

New Articles

  1. Tosti R, Iorio J, Fowler JR. Povidone-Iodine Soaks for Hand Abscesses: A Prospective Randomized Trial. J Hand Surg Am 2014;39(5):962-5. PMID: 24636027
  2. Tosti R, Trionfo A, Gaughan J, Iyas AM. Risk Factors Associated With Clindamycin-Resistant, Methicillin-Resistant Staphylococcus aureus in Hand Abscesses.  J Hand Surg Am2015;40(4):673-6. PMID: 25707549

Reviews

  1. Osterman M, Draeger R, Stern P. Acute Hand Infections.  J Hand Surg Am2014;39(8):1628-35. PMID: 25070032
  2. Ritting AW, O'Malley MP, Rodner CM. Acute Paronychia. J Hand Surg Am 2012;37(5):1068-70. PMID: 22305431

Classics

  1. Florey, W. Hand infections treated with penicillin. Lancet 1944;1:73-81.
Subscribe to CELLULITIS
⇡