Dermatological consultation in outpatients improves diagnosis of cellulitis

1. In the internal medicine outpatient setting, dermatology consultation increased diagnostic accuracy of cellulitis, thereby conserving antibiotic use. 

2. Conditions that were commonly mistaken for cellulitis included eczematous dermatitis, stasis dermatitis, and erythema chronicum migrans.  

Evidence Rating Level: 2 (Good) 

Study Rundown: Cellulitis is an infection of the skin and subcutaneous tissue that is most commonly caused by bacteria from the streptococcal and staphylococcal family.  It is frequently diagnosed in the outpatient setting and may require hospitalization in severe cases. The characteristics of cellulitis are non-specific (e.g. warmth, swelling, and pain), and thus, may be challenging to differentiate from other conditions that present similarly. In this study, the authors examined whether dermatology consultation for suspected cases of cellulitis would improve diagnostic accuracy. It was found that dermatologic consultation improved diagnostic accuracy of cellulitis. This study also identified conditions commonly mistaken for cellulitis, such as eczematous dermatitis, stasis dermatitis, and erythema chronicum migrans. Strengths of the study included its randomized study design.  A weakness of the study was its lack of histopathological verification for the diagnoses.

Click to read the study in JAMA Dermatology

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In-Depth [randomized controlled trial]: Twenty-nine patients were enrolled in the study. 20 were randomized to the treatment arm and were evaluated by board-certified dermatologists. 9 were randomized to the control arm and were only evaluated by primary care physicians.  2/20 (10%) patients in the treatment arm were diagnosed with cellulitis, and 5/20 (25%) received antibiotics (2 for cellulitis and 3 for erythema chronicum migrans).  In contrast, 9/9 (100%) of patients in the control arm were diagnosed with cellulitis, and all were treated with antibiotics. Comparatively, those patients with dermatologic consultation showed less antibiotic usage for cellulitis (2/20 vs. 9/9, p<0.001). Furthermore, upon dermatological evaluation of the 9 patients in the control group, only 3/9 (33%) were given a final diagnosis of cellulitis.  While no patient in the treatment arm was hospitalized, 1 patient in the control arm had to be hospitalized for his/her condition. Risk and demographic factors between groups were not statistically significant (p > 0.05).

More from this author: Mutation linked with decrease in cutaneous diffuse large B-cell lymphoma, Population-based risk factors and geographical trends identified for vitiligo, Rising incidence of merkel cell carcinoma reported in Queensland, Australia

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