painful, firm, ill defined erythematous swelling that feels warm
•Vesicles, bullae, pustules, and tissue necrosis may occur in cases of severe infection
•Regional lymph node enlargement may occur
The diagnosis is usually based on the clinical criteria. Blood culture, needle aspiration, and rarely, a biopsy can be done.
•Trauma
•Insect bites
•Erysipelas
•Venous thrombosis
•Superficial thrombophlebitis
•Panniculitis
•Sweet syndrome
•Vasculitis
•Acute parotitis
•Other inflammatory disorders
Basic Guidelines
•In the majority of cases treatment should be directed against S. pyogenes and S. aureus.
•Culture and antibiotic sensitivity tests should be done in severe and antibiotic-resistant cases.
•Treatment should be implemented rapidly to avoid complications.
•Hospitalization and parenteral antibiotics should be reserved for children with severe illness.
Suggested Therapies
•Empiric initial treatment can be instituted with one of the following drugs: oral cloxacil-lin 250-500 mg every 6 hours; oral diclox-acillin 125-500 mg every 6 hours; oral fluc-loxacillin 250-500 mg every 6 hours: or oral amoxicillin 250-500 mg every 8 hours. Mild cases require 10 days treatment.
•Oral ciprofloxacin 250-750 mg twice daily alone or in combination with metronidazole 250-500 mg every 8 hours may also be used, in particular in more severe cases.
Alternative Therapies
Oral levofloxacin 200-750 mg daily or twice daily is recommended for patients with complicated cellulitis. Recently, linezolid in a dose of 400 mg every 12 hours has been recommended.
References
Bouvet A. Cellulitis and necrotizing fasciitis: microbiology and pathogenesis. Ann Dermatol Venereol 2001;128:382–389.
Lewis R. Soft tissue infections. World J Surg 1998;22:146–151.
Matson KL, Miller SE. Tooth discoloration after treatment with linezolid. Pharmacotherapy 2003;23:682–685.
Sachs M. Cutaneous cellulitis. Arch Dermatol 1991;124:493–500.
Taylor CO, Carter JB. Buccal cellulitis in an infant due to ampicillin-resistant Haemophilus influenzae. J Oral Maxillofac Surg 1986;44:234–239.
Bullous Pemphigoid
Bullous pemphigoid is a chronic bullous disease primarily affecting the skin and. less often, the mucous membranes. It commonly affects middle-aged and elderly individuals.
Bullous pemphigoid is an autoimmune disease. Bullous pemphigoid antigens 180 (BP180) and 230 (BP230) have been identified as the target antigens, and autoantibodies to these antigens are pathogenetically critical.
The oral mucosa is affected in about 30-40% of cases and usually follows skin involvement. Bullous pemphigoid may rarely be associated with internal malignant disease.
Oral Mucosa
•Localized or scattered bullae that rupture leaving persistent painful erosions
•Palatal and buccal mucosa, tongue, lips, and gingiva are more frequently affected
•Rarely the oral lesions are the first manifestations
Other Mucosae
•Conjunctiva, esophagus, vagina, and anus are affected less frequently
Skin
•Nonspecific generalized rash and tense bullae, isolated or in dusters, that rupture leaving erosions without a tendency to extend peripherally
•Nikolsky sign is negative
The clinical diagnosis should be confirmed by histopathologic examination and direct and indirect immunofluorescence. Circulating anti-basement membrane antibodies can be found in the sera of about 70-80% of patients.
•Pemphigus
•Cicatricial pemphigoid
•Linear IgA disease
•Pemphigoid gestationis
•Epidermolysis bullosa acquisita
•Dermatitis herpetiformis
•Erythema multiforme
•Stevens-Johnson syndrome
•Bullous and erosive lichen planus
•Bullous systemic lupus erythematosus
Basic Guidelines
•Systemic and topical treatments should be used in the management of bullous pemphigoid depending on the severity of the disease. The age of the patient and the presence of other diseases should be also taken into consideration.
•Severe and moderate disease with oral lesions usually need systemic
