Recognition and Diagnosis of Cellulitis Is Improved by Dermatologic Consultation in the Outpatient Setting

There is no gold standard for the diagnosis of cellulitis. Failure to recognize it or to prescribe antibiotic therapy can be associated with morbidity and even mortality. However, it is clear that antibiotic therapy is overused, and it is possible that such overuse might produce resistant strains of bacteria. It is not infrequent in my practice, to be referred patients with “recalcitrant bilateral cellulitis” whose correct diagnosis is stasis dermatitis. Recognizing such patients before antibiotic use or hospitalization would likely be cost saving.

To test whether dermatology consults for patients with suspected cellulitis could reduce inappropriate treatment of mimicking conditions, these authors conducted a prospective, nonrandomized study at a major academic center. Among 29 patients diagnosed with cellulitis by primary care physicians, 20 were randomized to be seen by dermatology consultants before receiving antibiotic therapy (treatment group) and 9 were randomized to care only by their PCPs (control group). In the control group, one third received antibiotics and one patient was hospitalized. In the treatment group, only two patients (10%) had dermatologist-confirmed cellulitis. The rest received final diagnoses of eczematous dermatitis (n = 4); stasis dermatitis (3); erythema migrans (3); arthropod reaction (2); and one each phytophotodermatitis, gout, molluscum contagiosum, hematoma, erythema nodosum, and chronic paronychia.