Cellulitis in Child
In cellulitis, bacteria invade through breaks in the skin, including insect bites, puncture wounds, lesions from dermatitis, varicella, and burns. The clinical manifestations of cellulitis include rapidly progressive areas of skin edema, redness, warmth, and pain with or without associated lymphangitis or lymphadenitis. In children, cellulitis often occurs on the lower extremities and buttocks. Systemic symptoms of fever, malaise, and chills are common. In immunosuppressed individuals, the infection can spread to cause large abscesses, necrosis, and dissemination into blood. Predisposing factors include conditions that compromise the barrier function of the skin (such as atopic dermatitis) or weakened host defenses (such as malnutrition, obesity, trauma, chronic edema, cancer, and HIV infection).
Children with facial cellulitis are more often admitted to the hospital and may require multidisciplinary care, particularly if there is periorbital or orbital cellulitis present.
Recurrent cellulitis occurs less frequently in children as compared to adults; risk factors include lymphedema and rhinosinusitis (for periorbital cellulitis).
See the Infant / Neonate summary for information on cellulitis-adenitis syndrome.
Although many cases of cellulitis are attributable to Streptococcus spp, S aureus is another cause of cellulitis, and it is important to be cognizant of the rising prevalence of methicillin-resistant S aureus (MRSA) in communities. S aureus should be considered for purulent infections. In the outpatient setting, MRSA coverage should be added for patients whose cellulitis has not responded to antistaphylococcal beta-lactam therapy.
L03.90 – Cellulitis, unspecified
128045006 – Cellulitis
Differential Diagnosis & Pitfalls
- Suppurative lymphadenitis
- Staphylococcal scalded skin syndrome
- Perianal streptococcal dermatitis
- Impetigo, bullous impetigo
- Herpes zoster
- Erythema migrans of Lyme disease
- Erysipelas (bright red, well-demarcated plaque that may vesiculate; systemically unwell)
- Septic arthritis
- Id reaction
- Wells syndrome (eosinophilic cellulitis)
- Atopic dermatitis
- Contact dermatitis (allergic, irritant)
- Dermal hypersensitivity reaction
- Sweet syndrome
- Erythema nodosum