Layers of the Skin & Soft Tissue (out to in) with their corresponding infections:
- Epidermis -> erysipelas
- Dermis -> cellulitis
- Subcutaneous fat -> panniculitis
- Fascia -> fasciitis
- Muscle -> pyomyositis
CLINICAL PEARLS:
1. Differentiating erysipelas versus cellulitis
- Erysipelas has a raised, distinct border
- Cellulitis is less well demarcated
2. Gestalt...
- Red with no pus -> likely Group A Strep
- Red with lots of pus -> likely Staph
3. The number 1 bug for ALL layers is GROUP A STREP.
Number 2 is Staph.
4. Lympangitic streaking can be seen with cellulitis, but not with fasciitis because there is no lymphatic drainage of the fascia.
Recognize sepsis!!
Upon presentation, a patient's chance of dying is 5-10% with an MI, 15% with a stroke, and 50% with sepsis! Yet it remains under-recognized...
Treatment of cellulitis: (to cover both Strep and Staph)
#1 - Cefazolin / Cephalexin (first generation cephalosporins)
- Cloxacillin
- Vanco if suspecting MRSA
- If PCN allergy: Levofloxacin or moxifloxacin
Strep is highly resistant to Septra and Macrolides.
Doxycycline is good for Staph but not so great for GAS.
Click here for the IDSA practice guidelines for the Dx and Rx of SKIN AND SOFT TISSUE INFECTIONS.
