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Cellulitis is an infection of the skin and skin-associated structures with many clinical mimickers known collectively as pseudocellulitis. Dermatology or infectious disease consultation is considered the gold standard for diagnosis. We evaluated a prospective cohort of adult patients presenting to the emergency department (ED) with concern for lower extremity cellulitis who received dermatology consultation with conferral of a final diagnosis. Possible risk factors independently associated with cellulitis diagnosis (P.1) were included in a logistic regression model for prediction of cellulitis diagnosis. Factors having odds ratios with a confidence interval excluding 1 were identified as significant independent predictors. The study identified factors that should be considered in evaluation of patients with suspected uncomplicated lower extremity cellulitis.

Cellulitis is a common skin infection resulting in increasing hospitalizations and health care costs. There is no gold standard diagnostic test, making cellulitis a potentially challenging condition to distinguish from other mimickers. Physical examination typically demonstrates poorly demarcated unilateral erythema with warmth and tenderness. Thorough history and clinical examination can narrow the differential diagnosis of cellulitis and minimize unnecessary hospitalization. Antibiotic selection is determined by patient history and risk factors, severity of clinical presentation, and the most likely microbial culprit.

Cellulitis is frequently misdiagnosed owing to its clinical mimickers, collectively known as pseudocellulitis. This study investigated diffuse reflectance spectroscopy (DRS) alone and in combination with infrared thermography (IRT) for the differentiation of cellulitis from pseudocellulitis. A prospective cohort study at an urban academic hospital was conducted from March 2017 to March 2018. Patients presenting to the emergency department with presumed cellulitis were screened for eligibility, and 30 adult patients were enrolled. Dermatology consultation conferred a final diagnosis of cellulitis or pseudocellulitis. DRS measurements yielded a spectral ratio between 556 nm (deoxyhemoglobin peak) and 542 nm (oxyhemoglobin peak), and IRT measurements yielded temperature differentials between the affected and unaffected skin. Of the 30 enrolled patients, 30% were diagnosed with pseudocellulitis. DRS revealed higher spectral ratios in patients with cellulitis (P = 0.005). A single parameter model using logistic regression on DRS measurements alone demonstrated a classification accuracy of 77.0%. A dual parameter model using linear discriminant analysis on DRS and IRT measurements combined demonstrated a 95.2% sensitivity, 77.8% specificity, and 90.0% accuracy for cellulitis prediction. DRS and IRT combined diagnoses cellulitis with an accuracy of 90%. DRS and IRT are inexpensive and noninvasive, and their use may reduce cellulitis misdiagnosis.

Cutaneous manifestations have been associated with COVID-19 infection and their significance in hospitalized patients remains unclear. This study catalogues the exanthems observed in hospitalized COVID-19 patients to determine prevalence and inform clinicians in devising diagnostic and management strategies.

Cellulitis is a common skin infection resulting in increasing hospitalizations and health care costs. There is no gold standard diagnostic test, making cellulitis a potentially challenging condition to distinguish from other mimickers. Physical examination typically demonstrates poorly demarcated unilateral erythema with warmth and tenderness. Thorough history and clinical examination can narrow the differential diagnosis of cellulitis and minimize unnecessary hospitalization. Antibiotic selection is determined by patient history and risk factors, severity of clinical presentation, and the most likely microbial culprit.

Cellulitis is an infection of the skin and skin-associated structures sometimes presenting with purulence, defined by generation of pus.1 Purulent infections can further be complicated by cutaneous abscess, a walled collection of pus in the subcutaneous space. Research on paediatric cellulitis is limited, and antimicrobial treatment widely varies even among paediatric infectious disease providers with some studies suggesting overuse of broad antibiotic coverage.2-4 Methicillin-resistant Staphylococcus aureus (MRSA) infection in paediatric cellulitis can be challenging to diagnose and treat with appropriate antibiotic coverage. Nasal swabs are a polymerase chain reaction assay screening for the presence of MRSA that typically result within 24 hours, much faster than traditional microbial culture with sensitivities.5 This study assesses the performance of nasal swabs for predicting MRSA infections in our institution.

Background Calciphylaxis is a rare thrombotic vasculopathy characterized by high morbidity and mortality. There is a paucity of studies examining longitudinal outcomes. Objective To assess mortality, days spent in the hospital, and amputations in patients with calciphylaxis. Methods A retrospective medical record review was conducted in 145 patients diagnosed with calciphylaxis at an urban tertiary care hospital from January 2006 to December 2018. Results Six-month mortality was 37.2%, and 1-year mortality was 44.1%. Patients with nephrogenic calciphylaxis had worse survival than those with nonnephrogenic calciphylaxis (P = .007). This difference in survival disappeared when limiting mortality to deaths due to calciphylaxis. Age (P = .003) and end-stage renal disease (P = .01) were risk factors associated with 1-year mortality. Diabetes mellitus was associated with greater total hospitalization days (coefficient, 1.1; 95% confidence interval, 1.01-1.4); bedside debridement was associated with fewer hospitalization days (coefficient, 0.8; 95% confidence interval, 0.7-0.9). Amputations were not associated with any of the examined risk factors. The use of warfarin followed by a transition to nonwarfarin anticoagulation was associated with decreased hazard of death (P = .01). Limitations Retrospective nature. Conclusions Calciphylaxis remains a complex, heterogeneous disease. Mortality is lower in patients with nonnephrogenic disease. These findings may be incorporated during discussions regarding the goals of care to facilitate informed shared decision making.

Background: Cutaneous manifestations have been associated with COVID-19 infection and their clinical significance in hospitalized patients remains unclear Methods: A retrospective chart review of 1216 patients older than 18 years of age hospitalized with laboratory-confirmed SARS-CoV-2 infection from March 12, 2020 to May 31, 2020 at a large urban academic medical center A keyword search query of patient records combined with manual chart review by at least two dermatologists identified a study group having cutaneous manifestations concurrent with COVID-19 infection, specifically between 14 days prior to admission and up to discharge Results: 122 patients with 195 skin lesions concurrent with COVID-19 hospitalization were identified Dermatology reviewers evaluated clinical photographs for 116 lesions (59 5%) and inpatient dermatology consultations for 42 lesions (21 5%) The most common cutaneous findings in patients with COVID-19 hospitalization were pressure injuries (n=118;60 5%) and morbilliform eruptions (n=33;16 9%) A very small number of patients (0 6%;n=7/1216) had exanthems occurring within 2 weeks of COVID-19 symptom onset The majority of exanthems developed within 14 days of exposure to possible culprit drugs and beyond the 14-day window of COVID-19 symptom onset, making viral association unlikely Conclusion: Skin lesions concurrent with COVID-19 hospitalization were most frequently linked to hospitalization-related factors, such as pressure injuries or drug-related exanthems, rather than due to novel pathologies related to SARS-CoV-2 itself

Background: The World Health Organization recommends healthcare providers wear personal protective equipment (PPE) to prevent COVID-19 infection There are no universally accepted recommendations for PPE usage by healthcare providers when caring for asymptomatic patients who can transmit infection Objective: To survey PPE usage across medical dermatology practices and assess provider concern for COVID-19 transmission in the workplace Methods: An anonymous survey was distributed via e-mail to dermatologists with membership in the Society for Dermatology Hospitalists and the Association of Professors in Dermatology Questions pertained to use and perception of PPE in outpatient encounters The survey remained open for 6 weeks and reached a predetermined target response number of 50-100 dermatologists among 429 recipients Results: 88 dermatologists completed the survey (20 5%) and the majority practice in an outpatient clinic (80 7%) When caring for patients, most practices officially recommended utilizing a surgical mask (95 5%) and face shield (52 3%) Though a minority of practices recommended an N95 respirator (9 1%) or gloves (29 5%), a larger fraction of dermatologists self-reported using an N95 respirator (26 1%) and/or gloves (43 2%) 35 2% of dermatologists supplemented practice-provided PPE by providing personally obtained PPE, and 18 2% of dermatologists felt their institution did not adequately address their perceived risk of contracting COVID-19 42 0% of physicians perceived their risk of contracting COVID-19 at work to be moderate or high Conclusion: An appreciable fraction of dermatologists perceived their COVID-19 infection risk to be medium or high, and some dermatologists are taking supplemental safety measures This study calls attention to the level of provider-perceived risk and highlights opportunities to address provider concerns regarding COVID-19 transmission