Patient handout

Cellulitis & erysipelas (dermatology lens)

PRODUCTION

1. Your condition

This handout is for cellulitis & erysipelas (dermatology lens). Your care team identified this based on: unilateral warm, tender, expanding lower-leg erythema (idsa 2014 ssti stevens — classic non-purulent cellulitis; nice ng141 2019).

Other reasons your team may use this plan: sharply demarcated, raised, indurated erythema (erysipelas — superficial dermis + lymphatics; nice ng141 2019; idsa 2014 ssti stevens); acute "red leg" on a background of stasis dermatitis / lymphedema / leg ulcer / tinea pedis — high pseudocellulitis prior (raff jama dermatol 2016; david bjd 2011); ≥2 episodes/year cellulitis in the same limb — recurrent-cellulitis derm-prevention entry (thomas nejm 2013 patch ii; nice ng141 2019).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
diagnostic_confirmation_no_antibiotic_if_pseudocellulitis	—	—	—	Raff JAMA Dermatol 2016 — 30% of admitted cellulitis is pseudocellulitis; 92% received unnecessary antibiotics. Stasis dermatitis is treated as dermatitis (emollient + topical steroid + compression), NOT antibiotics.

Plan: Confirmed non-purulent cellulitis / erysipelas — narrow-spectrum (derm-first)

3. When to call your provider

Contact your care team if any of the following happen:

No improvement / progression beyond mark at 48-72 h after mimic re-excluded → ED IV / route to id.cellulitis.core.v1 (IDSA 2014 SSTI Stevens)
Necrotizing features → emergent surgery, route to id.necrotising-fasciitis.core.v1 (IDSA 2014 SSTI Stevens)
Systemic toxicity / qSOFA ≥2 → route to id.sepsis.core.v1 (SSC 2021)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Pain out of proportion, dusky/violaceous skin, hemorrhagic bullae, crepitus, cutaneous anesthesia, or rapidly advancing margin (IDSA 2014 SSTI Stevens)(life-threatening)
qSOFA ≥2, hypotension on adequate fluids, or Eron IV systemic toxicity with skin source (SSC 2021; Eron 2003)
Erythema advances beyond the dated marked border or systemic features at 48-72 h despite appropriate narrow-spectrum therapy (IDSA 2014 SSTI Stevens; NICE NG141 2019)

5. Follow-up

DERMATOLOGY RECURRENCE PREVENTION (the core differentiator of this engine): eradicate + maintain tinea pedis control (recurrent risk if untreated — Dupuy BMJ 1999); lifelong emollient barrier repair for eczema/xerosis; compression + lymphedema therapy (decongestive) to reverse the recurrence substrate (Webb NEJM 2020 — compression halved recurrence); chronic venous insufficiency / stasis-dermatitis derm management; PATCH II penicillin V 250 mg BID × 12 mo if ≥2 episodes/year (Thomas NEJM 2013 — 45% relative recurrence reduction); derm referral for recurrent / atypical / ulcerated / diagnostically uncertain disease.

6. Sources

Guideline: IDSA 2014 SSTI Guideline (Stevens et al, CID) + NICE NG141 Cellulitis & erysipelas (2019, evidence-reviewed 2024) + Eron 2003 / CREST 2005 severity classification + Raff & Kroshinsky JAMA Dermatol 2016 pseudocellulitis + Thomas NEJM 2013 PATCH II recurrence prophylaxis + Webb NEJM 2020 compression-for-recurrence + Hepburn 2004 short-course duration