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Cellulitis is a soft tissue infection that involves the skin and subcutaneous tissues. Facial cellulitis is most commonly caused by Streptococcus pyogenes and Staphylococcus aureus, with an increasing predominance of methicillin-resistant Staphylococcus aureus (MRSA). Less commonly, cellulitis may represent an extension from a deeper facial infection. Cellulitis is characterized by erythema, edema, warmth, pain, and loss of function. Clinical features of a well-defined, palpable border are absent.
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The diagnosis of cellulitis is clinical. Laboratories and blood cultures may be needed for severe illness, immunocompromise, or other significant comorbidities. Ultrasound and computed tomography (CT) may be used to evaluate for abscess. In most cases, treatment involves analgesics and oral antibiotics for 7 to 14 days. Antibiotic recommendations are listed in Tables 150-1 and 150-2. Consider hospitalization and parenteral antibiotics for patients with signs of systemic illness, failed outpatient therapy, or significant comorbidities.
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