Usually, cellulitis is a straightforward diagnosis to the dermatologist, but atypical presentations and a list of clinically similar dermatoses mimicking the condition can confuse the clinician and lead to misdiagnosis. Accurately recognizing the variants of cellulitis and its differential diagnoses is crucial to diagnose the condition and prescribe appropriate therapy.
"It is not uncommon that the subtle nuances of cellulitis as well as several conditions which appear to be clinically similar are easily mistaken for a true cellulitis, which can often lead to a misdiagnosis by nondermatologists," says Daniela Kroshinsky, M.D., director of pediatric dermatology, department of dermatology, Massachusetts General Hospital, Boston.
The predisposing factors for cellulitis can include trauma, fungal infections, chronic ulcers and cutaneous infection or any compromise of the integrity of the skin. Streptococcus pyogenes, Staphylococcus aureus (both methicillin-sensitive Staphylococcus aureus, MSSA, and methicillin-resistant Staphylococcus aureus, MRSA) can all cause a cellulitis in adults, whereas Staphylococcus aureus is the most common pathogen in children. The standard therapy for non-complicated cellulitis is antibiotics such as cephalosporins, whereas a regimen of doxycycline or co-trimoxazole can be used for resistant strains.
"The misdiagnosis of cellulitis can result in physicians empirically administering aggressive antibiotic regimens," she says. "Unfortunately, this blind therapy may not effectively treat the condition and may result in the bacterial resistances often seen in soft-tissue infections. Therefore, a correct diagnosis is crucial in the timely administration of appropriate therapy."