Cellulitis is the most superficial of hand infections and may be treated definitively with antibiotics if diagnosed early enough in its course. Diagnosis is made by documenting erythema, warmth, and edema to the affected portion of the hand. The examiner must document lack of involvement of any deeper structures in the hand. Specifically, range of motion of the digits, hand, or wrist should not be uncomfortable for the patient, and palpation of the deeper structures of the hand should not produce any tenderness.
The most common offending organism is Streptococcus pyogenes, although S. aureus and other pathogens are identified occasionally. An antistaphylococcal penicillin or first-generation cephalosporin is recommended for initial treatment. 4 For more extensive involvement, parenteral antibiotics should be instituted. Inpatient management should be reserved for patients who are immunocompromised or systemically ill and for rapidly spreading infections.
The hand should be immobilized in a position of function, and the patient should keep the hand elevated at all times. Finally, close follow-up should be arranged, with reexamination occurring within the next 24 h.
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