Clinical features |
Most commonly on the lower extremities.
Predisposing factors may include tinea pedis of the toe web with fissuring, IV drug use, open ulcerations, diabetes.
Presence of tenderness, erythema, and edema.
May be accompanied by systemic symptoms, such as chills, fever, and malaise progress ing to septicemia.
Blood studies show leukocytosis and neutrophilia, and blood cultures may be positive. |
Management |
Consult medicine to determine severity of cellulitis (particularly patients with moderate to severe disease, diabetes, and immunocompromised status) and guidance regarding further treatment.
IV antibiotics may be required for the first 24-72 h.
Possible cases warranting IV antibiotics include large area associated with sys temic symptoms, deep ulcer, osteomyelitis, abscess, comorbid diabetes.
Mild cases or following initial IV therapy, administer dicloxacillin or cephalexin 250-500 mg QID for 5-10 d.
Additionally, demarcate the area of the cellulitis, elevate extremity, and apply warm compresses to infected area TID.
Culture may be indicated in the presence of an ulcer, pustule, or abscess.
If present, treat coexisting tinea pedis with topical antifungals to prevent recurrence of lower extremity cellulitis.
Ensure diabetic patients receive counseling regarding periodic foot examination and the importance of foot hygiene and properly fitting shoe gear. |
