Cellulitis and Its Imposters...

CELLULITIS IS A POTENTIALLY SERIOUS bacterial infection of the dermis and subcutaneous tissue characterized by erythema, pain, warmth, and swelling. Misdiagnosis of cellulitis is common, since other noninfectious, nonnecrotizing, inflammatory conditions of the dermis or subcutis may present similarly. A recent multicenter retrospective study reviewed 1,430 inpatient dermatology consultations requested for the assessment of cellulitis and found that about 75% of cases of cellulitis were misdiagnosed.1 The most common cellulitis mimickers were stasis dermatitis, contact dermatitis, tinea pedis, and drug eruption. A similar study done in the United Kingdom suggested that inpatient dermatology consult teams can increase diagnostic accuracy while also providing substantial savings for healthcare systems.2 Medical schools and residency programs might also consider incorporating more comprehensive education regarding the diagnosis and management of cellulitis. Additional potential solutions include establishing cellulitis clinics, increasing rapid access to dermatology consultation, and increasing education for ED physicians and hospitalists.3 Increasing diagnostic accuracy will likely improve patient care and create financial savings for patients and hospitals alike. Physicians and students should be familiar with cellulitis mimickers such as stasis dermatitis, lipodermatosclerosis, allergic contact and irritant dermatitis, asteatotic eczema (eczema craquelé), and lichen simplex chronicus. To see clinical information and over 20 images of the morphological variations of cellulitis, visit VisualDx. References: 1. Strazzula L, Cotliar J, Fox LP, et al. Inpatient dermatology consultation aids diagnosis of cellulitis among hospitalized patients: A multi-institutional analysis. J Am Acad Dermatol. 2015;73(1):70-75. 2. Levell NJ, Wingfield CG, Garioch JJ. Severe lower limb cellulitis is best diagnosed by dermatologists and managed with shared care between primary and secondary care. Br J Dermatol. 2011;164(6):1326-1328. 3. Hughey LC. The impact dermatologists can have on misdiagnosis of cellulitis and overuse of antibiotics: closing the gap. JAMA Dermatol. 2014;150(10):1061-1062.