Hand cellulitis

Background

Wrist and hand deeper palmar dissection

• Remove rings if infections are near the digits

Clinical Features

Hand cellulitis (from cat bite).

Hand cellulitis (from cat bite).

Lymphadenitis extending from hand cellulitis.

• Erythema, warmth, and edema
• Range of motion of digits, hand, and wrist should not be painful
  • Pain predicts extensive involvement and the need for inpatient management

Differential Diagnosis

Hand and finger infections

• Bed bugs
• Closed fist infection (Fight Bite)
• Hand cellulitis
• Hand deep space infection
• Hand-foot-and-mouth disease
• Herpetic whitlow
• Felon
• Flexor tenosynovitis
• Paronychia
• Scabies
• Sporotrichosis

Look-Alikes

• Digital mixoid cyst

Evaluation

• Usually clinical
• Consider films and ultrasound to evaluate for osteomyelitis, abscess, or necrotizing cellulitis

Management

• Mild/moderate cellulitis
  • TMP-SMX DS 1-2 tab PO x 7-10d + (cephalexin 500mg PO QID x7-10d OR dicloxacillin 500mg PO QID x 7–10d)
• Severe cellulitis
  • Vancomycin 1gm IV q12hr

Disposition

• Consider admission for:
  • Immunocompromised
  • Clinical toxicity
  • Evidence of deep-space involvement
  • Rapidly spreading infections

See Also

• Hand and finger infections
• Cellulitis