Cellulitis & Necrotising Fasciitis

Key points

• Cellulitis: spreading erythema, warmth, tenderness — usually streptococcal; treat with flucloxacillin (clarithromycin if penicillin-allergic).
• Severe/systemically unwell → IV antibiotics; mark margins to track spread.
• Necrotising fasciitis: severe pain out of proportion, dusky discolouration, bullae, crepitus, rapid progression — SURGICAL EMERGENCY.
• LRINEC score aids suspicion (CRP, WCC, Hb, sodium, creatinine, glucose).
• Management: immediate surgical debridement + broad-spectrum IV antibiotics (e.g. meropenem + clindamycin).

Decision points in this pathway

• Pain out of proportion + dusky skin/bullae/crepitus/rapid spread?

The full step-by-step algorithm, including what to do at each branch, opens in the app for approved members.