Cellulitis is a severe infection of the soft tissues, with a variable aetiology from Gram-positive to Gram-negative bacteria and deep fungal infections, whose early recognition is mandatory to avoid potentially life threatening complications. Some pathogens might cause very similar clinical entities, and cellulitis differentiation at presentation towards abscess, necrotising fasciitis, and gangrene, requires expertise. Many mimics are also to be excluded, conditioning the treatment and patient’s prognosis. The dermatologist is in a lead position to avoid misdiagnosis, to evaluate the type of assessment, and address initial treatment. Besides, skin and soft tissue infections are a common reason for emergency room visits and hospital admission, lacking precise clinical definition and managed with empirical antibiotic treatments. History, physical examination and laboratory data can help characterise the severity of the disease, and the probability of complications development, mainly necrotising fasciitis. Several admittance scores have been proposed to address the emergency decisions, and guidelines for treatment proposed. The present review will focus on clinical challenges and actual open questions on cellulitis management.
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