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Cellulitis: A Review of Current Practice Guidelines and Differentiation from Pseudocellulitis

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Abstract

Cellulitis, an infection involving the deep dermis and subcutaneous tissue, is the most common reason for skin-related hospitalization and is seen by clinicians across various disciplines in the inpatient, outpatient, and emergency room settings, but it can present as a diagnostic and therapeutic challenge. Cellulitis is a clinical diagnosis based on the history of present illness and physical examination and lacks a gold standard for diagnosis. Clinical presentation with acute onset of redness, warmth, swelling, and tenderness and pain is typical. However, cellulitis can be difficult to diagnose due to a number of infectious and non-infectious clinical mimickers such as venous stasis dermatitis, contact dermatitis, eczema, lymphedema, and erythema migrans. Microbiological diagnosis is often unobtainable due to poor sensitivity of culture specimens. The majority of non-purulent, uncomplicated cases of cellulitis are caused by β-hemolytic streptococci or methicillin-sensitive Staphylococcus aureus, and appropriate targeted coverage of this pathogen with oral antibiotics such as penicillin, amoxicillin, and cephalexin is sufficient. Even with rising rates of community-acquired methicillin-resistant Staphylococcus aureus, coverage for non-purulent cellulitis is generally not recommended.

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Authors and Affiliations

  1. The Ohio State University College of Medicine, Columbus, OH, USA

    Michelle A. Boettler

  2. Division of Dermatology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Benjamin H. Kaffenberger & Catherine G. Chung

  3. Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Catherine G. Chung

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  1. Michelle A. Boettler
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  2. Benjamin H. Kaffenberger
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  3. Catherine G. Chung
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Correspondence to Catherine G. Chung.

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Michelle Boettler, Benjamin Kaffenberger and Catherine Chung state no conflicts of interest.

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All authors contributed to the review conception and design. The first draft of the manuscript was written by Michelle Boettler and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Boettler, M.A., Kaffenberger, B.H. & Chung, C.G. Cellulitis: A Review of Current Practice Guidelines and Differentiation from Pseudocellulitis. Am J Clin Dermatol 23, 153–165 (2022). https://doi.org/10.1007/s40257-021-00659-8

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