Furunculosis and cellulitis

Published on 11/06/2015 by admin

Filed under Pediatrics

Last modified 22/04/2025

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Section 4: Red Papules and Nodules

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DDx Ref 25 • 91 • 80

Staphylococcal furunculosis. Mutliple tender red nodules on a teen’s arm.

Cellulitis of cheek of child with red, tender skin surrounding puncture wound.

Streptococcal perianal cellulitis. Infant with tender red perianal skin.

Blistering distal dactylitis. Red, tender fingertips and peeling skin in a preschool boy.

Furunculosis appears as tender red nodules and confluence of several adjacent furuncles produces a skin abscess. S. aureus is most commonly responsible for childhood furunculosis, but Gram-negative organisms such as Pseudomonas are occasionally responsible.

Cellulitis appears as tender, warm, red plaques with ill-defined borders. Regional adenopathy and fever are seen with cellulitis. In infants and toddlers, cellulitis may be seen over joints such as hip, shoulder or knee. Extension into the joint cavity creating a septic arthritis is a concern.

Streptococcus is usually responsible and sepsis may result. Staphylococcal cellulitis can also occur but extends more slowly than streptococcal cellulitis.

Perianal cellulitis is seen in infants and toddlers as perirectal redness and tender skin. Pain upon defecation is common. Perivaginal extension may be seen.

Blood cultures may be more reliable than local cultures in identifying the responsible bacteria.

The treatment of choice for furunculosis or abscesses is surgical incision and drainage.

More severe cases may require systemic antistaphylococcal antibiotics such as dicloxacillin 15−50 mg/kg/day or cephalexin 40−50 mg/kg day for 7 to 10 days.

Cellulitis including perianal cellulitis and blistering distal dactylitis should be treated with benzathine penicillin 600 000 to 1 200 000 units IM or oral penicillin V at 30−60 mg/kg/day. If staphylococcal infection is suspected, then antistaphylococcal antibiotics such as those for furunculosis should be used.