Cellulitis differential diagnosis: Difference between revisions
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==Distinguishing Disease from other Conditions== | ==Distinguishing Disease from other Conditions== | ||
Cellulitis can be promptly diagnosed with an appropriate history and physical exam. Administration of an antibiotic therapy will initiate resolution of the condition in 2-3 days. Differentials have to be thought of only when resolution is not seen. Non- resolution of cellulitis can be due to infection by resistant strains of the bacterium involved. | Cellulitis can be promptly diagnosed with an appropriate history and physical exam. Administration of an antibiotic therapy will initiate resolution of the condition in 2-3 days. Differentials have to be thought of only when resolution is not seen. Non- resolution of cellulitis can be due to infection by resistant strains of the bacterium involved. | ||
There are many dermatological conditions which manifest in manner similar to cellulitis. Careful evaluation of each case, based on accurate history and physical examinations, is very important. Differentials are as follows: | There are many dermatological conditions which manifest in manner similar to cellulitis. Careful evaluation of each case, based on accurate history and physical examinations, is very important. Differentials are as follows: | ||
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* Erysipelas is a skin infection similar to Cellulitis , but it affects superficial layers of the skin. It has more demarcated edges than cellulitis. | * Erysipelas is a skin infection similar to Cellulitis , but it affects superficial layers of the skin. It has more demarcated edges than cellulitis. | ||
* Erysipeloid is a skin infection which is mostly occupational in nature. It is most commonly seen in | * Erysipeloid is a skin infection which is mostly occupational in nature. It is most commonly seen in people involved in the poultry and meat industry. It is characterized by local lesions, diffuse lesions and systemic forms. | ||
* Deep vein thrombosis | * Deep vein thrombosis is a condition in which a blood clot is formed in the deep veins. It can be differentiated from cellulitis by the presence of tenderness along the clotted vein. Duplex ultrasonography would reveal the clot in the vein. | ||
* Necrotizing fasciitis | * Necrotizing fasciitis looks like cellulitis at the onset of the disease but it is much more serious. Large amounts of pain ,necrosis and bullae are noticeable. It often requires surgical exploration. | ||
There are few conditions which can be misdiagnosed as cellulitis like, thrombophlebitis, contact dermatitis, insect stings, drug reactions, arthritis.<ref name="pmid15630108">{{cite journal| author=Falagas ME, Vergidis PI| title=Narrative review: diseases that masquerade as infectious cellulitis. | journal=Ann Intern Med | year= 2005 | volume= 142 | issue= 1 | pages= 47-55 | pmid=15630108 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15630108 }} </ref> | There are few conditions which can be misdiagnosed as cellulitis like, thrombophlebitis, contact dermatitis, insect stings, drug reactions, arthritis.<ref name="pmid15630108">{{cite journal| author=Falagas ME, Vergidis PI| title=Narrative review: diseases that masquerade as infectious cellulitis. | journal=Ann Intern Med | year= 2005 | volume= 142 | issue= 1 | pages= 47-55 | pmid=15630108 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15630108 }} </ref> | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Aditya Govindavarjhulla, M.B.B.S.
Overview
Disease should be distinguished from thrombophlebitis, contact dermatitis, insect stings, drug reactions, and arthritis.
Distinguishing Disease from other Conditions
Cellulitis can be promptly diagnosed with an appropriate history and physical exam. Administration of an antibiotic therapy will initiate resolution of the condition in 2-3 days. Differentials have to be thought of only when resolution is not seen. Non- resolution of cellulitis can be due to infection by resistant strains of the bacterium involved.
There are many dermatological conditions which manifest in manner similar to cellulitis. Careful evaluation of each case, based on accurate history and physical examinations, is very important. Differentials are as follows:
- Erysipelas is a skin infection similar to Cellulitis , but it affects superficial layers of the skin. It has more demarcated edges than cellulitis.
- Erysipeloid is a skin infection which is mostly occupational in nature. It is most commonly seen in people involved in the poultry and meat industry. It is characterized by local lesions, diffuse lesions and systemic forms.
- Deep vein thrombosis is a condition in which a blood clot is formed in the deep veins. It can be differentiated from cellulitis by the presence of tenderness along the clotted vein. Duplex ultrasonography would reveal the clot in the vein.
- Necrotizing fasciitis looks like cellulitis at the onset of the disease but it is much more serious. Large amounts of pain ,necrosis and bullae are noticeable. It often requires surgical exploration.
There are few conditions which can be misdiagnosed as cellulitis like, thrombophlebitis, contact dermatitis, insect stings, drug reactions, arthritis.[1]
- Contact Dermatitis , is an inflammation of the skin in response to direct exposure to an allergic or irritant substance.They usually present with papular erythematous indistinct margins. Extent of distribution is often limited to area of exposure.
- Insect Bites, cause a local reaction leading to erythema, tenderness, pruritus and edema. In severe reaction it can be involve adjacent joints. In very severe cases it can even lead to anaphylaxis also.
- Drug rash, is the cutaneous form of drug reactions. It is quite variable ranging from pinkish hue to an exanthem. It can be limited or widespread. Itching is the most common symptom. If fever, dehydration and involvement of membranous surfaces is seen then other diagnosis has to be thought of. Most common drugs being Sulfa, Anticonvulsant drugs, Insulin from animal sources.
- Arthritis, it commonly presents as pain in the joints but at times it can be severe enough to present as erythema. At times Septic arthritis can infect overlying skin and can cause cellulitis.
- Some autoimmune conditions may mimic and at times can cause cellulitis. Panniculitis, Familial Mediterranean Fever, HyperIgD syndrome ususally mimic with presentations of erythema and few systemic symptoms.
- In Leukemic patients , some times tumour cells infiltrate the skin cause erythema,pappules and nodules. It may confused with cellulitis as patients are at increased risk owing to there immunodeficient state.It has to be differentiated using immunostaining.
References
- ↑ Falagas ME, Vergidis PI (2005). "Narrative review: diseases that masquerade as infectious cellulitis". Ann Intern Med. 142 (1): 47–55. PMID 15630108.