Facial cellulitis: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Erythema, edema, warmth, pain | *Erythema, edema, warmth, pain | ||
*Can be associated with chronic illness, trauma, insect bites, allergen exposure, dental caries, radiation exposure | *Can be associated with chronic illness, [[trauma]], [[insect bites]], [[allergen exposure]], [[dental caries]], [[radiation exposure]] | ||
*Consider severe illness or sepsis with systemic symptoms (fever, tachycardia, hypotension, AMS) | *Consider severe illness or sepsis with systemic symptoms ([[fever]], [[tachycardia]], [[hypotension]], [[AMS]]) | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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'''Immunologic''' | '''Immunologic''' | ||
*[[Systemic lupus erythematosus]] | *[[Systemic lupus erythematosus]] | ||
*Vancomycin flushing reaction | *[[Vancomycin]] flushing reaction | ||
*Angioneurotic edema | *Angioneurotic edema | ||
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==Management== | ==Management== | ||
#Analgesics | |||
#Remove foreign bodies from affected area if possible | |||
#Abscesses should be drained | |||
#Antibiotics (see below) | |||
===[[Antibiotics]]=== | ===[[Antibiotics]]=== | ||
Latest revision as of 19:51, 27 January 2017
Background
- Superficial soft tissue infection of the face
- Most commonly caused by S. pyogenes and S. aureus, including MRSA
Risk Factors
- immunosuppression
- diabetes
- vascular injury (due to radiation or trauma)
- foreign bodies
Clinical Features
- Erythema, edema, warmth, pain
- Can be associated with chronic illness, trauma, insect bites, allergen exposure, dental caries, radiation exposure
- Consider severe illness or sepsis with systemic symptoms (fever, tachycardia, hypotension, AMS)
Differential Diagnosis
Facial cellulitis
Infectious
- Cellulitis
- Impetigo
- Erysipelas
- Viral exanthem
- Parotitis
- Necrotizing fasciitis
- Anthrax
- Herpes zoster
- Malignant otitis externa
Trauma
- Soft tissue contusion
- Burn
Inflammatory
- Insect bite
- Apical abscess
- Contact dermatitis
Immunologic
- Systemic lupus erythematosus
- Vancomycin flushing reaction
- Angioneurotic edema
Skin and Soft Tissue Infection
- Cellulitis
- Erysipelas
- Lymphangitis
- Folliculitis
- Hidradenitis suppurativa
- Skin abscess
- Necrotizing soft tissue infections
- Mycobacterium marinum
Look-A-Likes
- Sporotrichosis
- Osteomyelitis
- Deep venous thrombosis
- Pyomyositis
- Purple glove syndrome
- Tuberculosis (tuberculous inflammation of the skin)
Evaluation
- Diagnosis is clinical
- Consider labs, blood culture if patient is immunocompromised, risk factors, renal dysfunction
- Bedside ultrasound to identify abscess
- CT can identify deep, extensive infection that involve soft tissues of neck or pharynx
Management
- Analgesics
- Remove foreign bodies from affected area if possible
- Abscesses should be drained
- Antibiotics (see below)
Antibiotics
Tailor antibiotics by regional antibiogram
Outpatient
- 5 day treatment duration
- Cephalexin 500mg PO q6hrs OR
- Add DS 1 tab PO BID if MRSA suspected
- Clindamycin 450mg PO TID covers Strep and Staph
- Cephalexin 500mg PO q6hrs OR
Pediatric Outpatient
- Cephalexin 25-50mg/kg/day PO divided q6-8h (max 500mg/dose) OR
- Add 8-12mg/kg/day (TMP) PO divided BID if MRSA suspected
- Clindamycin 30-40mg/kg/day PO divided TID (max 1.8g/day)
Inpatient
- Vancomycin 20mg/kg IV q12hrs OR
- Clindamycin 600mg IV q8hrs OR
- Linezolid 600mg IV q12hrs OR
- Daptomycin 4mg/kg IV once daily
Pediatric Inpatient
- Vancomycin 15mg/kg IV q6hrs OR
- Clindamycin 10-13mg/kg IV q8hrs (max 900mg/dose) OR
- Linezolid <12yr: 10mg/kg IV q8hrs; >12yr: 600mg IV q12hrs
- Doxycycline 100mg PO/IV q12hrs daily + Cefepime 1g IV q12hrs x 10 days
- Ciprofloxacin 400mg IV q12hrs x 10 days
- Ciprofloxacin 500mg PO q12hrs x 10 days
- TMP/SMX 2 DS tablets PO q12hrs x 10 days
- Ceftriaxone 1g (50mg/kg) IV q24hrs
Disposition
- Most patients can be treated with oral antibiotics as outpatient
Consider admission for:
- systemic signs of sepsis
- antibiotic intolerance
- immunosuppression
- extensive areas of erythema or induration
- foreign bodies that cannot be removed in ED
- failure of outpatient therapy