Skin and Soft Tissue Infections

Cellulitis

  • Deep dermis and subcutaneous tissue
  • Poorly demarcated borders, erythema, edema, warmth, fever
  • Mostly caused by streptococcal species, sometimes by staphylococcus species
  • Treatment
    • Purulent
      • Systemic toxicity/severe infection: IV Vancomycin (or Daptomycin)
      • No systemic toxicity: Treatment varies dependent upon multiple factors. Ultimately, the patient needs coverage for at least MRSA (Doxycycline, clindamycin, trimethoprim-sulfamethoxazole) with potential need for additional coverage if there is significant necrosis or if the lesion is perioral or perirectal.
    • Non-purulent
      • MRSA risk factors (group/nursing homes, recent antibiotic use, IV drug use):
        • Systemic toxicity/severe infection: IV Vancomycin (or Daptomycin)
        • No systemic toxicity: Amoxicillin + doxycycline, or clindamycin
      • No MRSA risk factors: Cephalexin, dicloxacillin, clindamycin

Erysipelas

  • Superficial dermis
  • Sharply demarcated borders, fevers, chills, malaise, headache
  • Almost exclusively streptococcal species
  • Treatment
    • Systemic symptoms (fevers, chills, etc.): Cefazolin or Ceftriaxone
    • No systemic symptoms: Amoxicillin, Clindamycin, Cephalexin

Impetigo

  • Epidermis
  • Papules -> vesicles surrounded by erythema -> pustules with thick golden crust. May or may not have bullae
  • Primarily caused by staphylococcal species, sometimes by streptococcal species
  • Treatment:
    • Topical mupirocin
    • PO cephalexin or dicloxacillin if multiple clusters

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