What are the signs and symptoms of cellulitis?

Updated: Jun 14, 2019
  • Author: Thomas E Herchline, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Nonpurulent cellulitis is associated with the 4 cardinal signs of infection, as follows:

  • Erythema

  • Pain

  • Swelling

  • Warmth

Physical examination findings that suggest the most likely pathogen include the following:

  • Skin infection without underlying drainage, penetrating trauma, eschar, or abscess is most likely caused by streptococci; Staphylococcus aureus, often community-acquired MRSA, is the most likely pathogen when these factors are present [1]

  • Violaceous color and bullae suggest more serious or systemic infection with organisms such as Vibrio vulnificus or Streptococcus pneumoniae

The following findings suggest severe infection:

  • Malaise, chills, fever, and toxicity

  • Lymphangitic spread (red lines streaking away from the area of infection)

  • Circumferential cellulitis

  • Pain disproportionate to examination findings

Indications for emergent surgical evaluation are as follows [2] :

  • Violaceous bullae

  • Cutaneous hemorrhage

  • Skin sloughing

  • Skin anesthesia

  • Rapid progression

  • Gas in the tissue

  • Hypotension

See Clinical Presentation for more detail.

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