Overview

Please Note, pathway redesign currently underway.

Please contact SPCA on 0300 421 0300 to refer to IV therapy team or Rapid Response.

If out of SPCA referral hours please contact Rapid Response Lead on 0300 421 6900

For further information or to add comment to the pathway, please leave feedback on this website which will be passed on.

Definitions and Differential Diagnosis

Definitions and Differential Diagnosis (taken from the GHT Protocol)

Cellulitis is an acute, non contagious infection of the skin and dermis and is characterised by erythema, oedema and warmth, accompanied by pain and tenderness. It is caused by an acute spreading bacterial infection that extends beyond the dermis, deep into subcutaneous tissues and may follow a skin abrasion or similar trauma.

  • Potential site of entry – insect bite/leg ulcer/traumatic wound/ tinea pedis  Lymphoedema
  • Leg oedema
  • Venous insufficiency/peripheral vascular disease
  • Obesity
  • Diabetes

  • Deep venous thrombosis – there will be absence of systemic symptoms related to a bacterial infection e.g. fever and pain may be associated with collateral vein dilation
  • Venous eczema – skin is typically itchy as well as crusting or scaling; more likely to be bilateral. It describes severe infection that extends beyond the dermis, deep into subcutaneous tissue
  • Lower leg oedema with secondary blistering ( usually bilateral)
  • Vasculitis
  • Necrotising fasciitis - Patients usually complain of intense pain that may seem in excess given the external appearance of the skin. Typically they have a fever and appear very ill. With progression of the disease, tissue becomes swollen, often within hours. Diarrhoea and vomiting are also common symptoms.

Consideration should be given regarding referral to specialist services at any stage of this pathway:

  • Dermatologist
  • Diabetologist
  • Podiatrist
Treatment of Cellulitis with Intravenous Antibiotics in the Community Pathway

                                      

                                                     

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