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FACIAL CELLULITIS, ERYSIPELAS, AND IMPETIGO

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Cellulitis and erysipelas are discussed in detail in the chapter 147, "Soft Tissue Infections." Impetigo is discussed in the chapter 136, "Rashes in Infants and Children." The differential diagnosis of facial infections is provided in Table 243-1.1

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TABLE 243-1Differential Diagnosis of Superficial Facial Infection
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Cellulitis is a superficial soft tissue infection that lacks anatomic constraints.2,3,4 Facial cellulitis is caused most commonly by Streptococcus pyogenes (group A β-hemolytic) and Staphylococcus aureus,4 with an increasing predominance of methicillin-resistant S. aureus.5 Less commonly, cellulitis may represent extension from deep space infections (see "Masticator Space Infection" section below). In children, buccal cellulitis from Haemophilus influenzae is now very uncommon if children have received the H. influenzae type b vaccine.6

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Bedside US can exclude or identify facial abscess (Figure 243-1). CT can identify deep-seated, extensive infections that involve the soft tissues of the neck or pharynx.

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FIGURE 243-1.

Cellulitis versus abscess. The image on the left shows the cobblestoned appearance of cellulitis, while the one on the right shows a heterogenous fluid collection of abscess. [Photo contributed by R. Gordon, MD.]

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Treatment is provided in Table 243-2. Duration of therapy is not well ...

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