dermatologic disorders
Cellulitis
Symptoms and Signs of Cellulitis
Infection is most common in the lower extremities. Cellulitis is typically unilateral; Stasis Dermatitis closely mimics cellulitis but is usually bilateral. The major findings are local erythema and tenderness and, in more severe infections, often lymphangitis and regional lymphadenopathy. The skin is warm, erythematous, and edematous, often with surface appearance resembling the skin of an orange (peau d’orange). The borders are usually indistinct, except in Erysipelas (a type of cellulitis with sharply demarcated margins). Petechiae are common; large areas of ecchymosis are rare. Vesicles and bullae may develop and rupture, occasionally with necrosis of the involved skin. Cellulitis may mimic deep venous thrombosis but can often be differentiated by one or more features (see table). Feature Feature Cellulitis Cellulitis Deep Venous Thrombosis Deep Venous Thrombosis Skin temperature Warm Normal or warm (rarely cool unless limb ischemia present due to extensive venous disease causing arterial insufficiency) Skin color Erythematous Normal or erythematous but blanchable (infrequently cyanotic) Skin surface Peau d’orange Smooth Lymphangitis and regional lymphadenopathy Frequent Nonexistent Most cellulitis is nonpurulent. However, cellulitis sometimes is accompanied by one or more pustules, Furuncles and Carbuncles , or Fever, chills, tachycardia, headache, hypotension, and delirium (usually indicating severe infection) may precede cutaneous findings by several hours, but many patients do not appear ill. Leukocytosis is common. Cellulitis with rapid spread of infection, rapidly increasing pain, hypotension, delirium, or skin sloughing, particularly with bullae and fevers, suggests life-threatening infection. 