The Quest for a More Accurate Diagnosis of Cellulitis

Abstract

For most physicians, cellulitis is one of the classic "I know it when I see it" diseases, in which a diagnosis is rendered, antibiotics initiated, and the patient is quickly out of sight and out of mind. Unfortunately, being common and being simple are not the same, and more than one-third of patients suspected to have cellulitis are incorrectly diagnosed. 1,2 The cumulative burden of misdiagnosis results in unnecessary antibiotic use, hospitalizations, and tremendous health care expenditures. 3,4 In this issue of JAMA Dermatology, Pulia et al 5 performed a prospective prognostic validation study of 2 point-of-care tools previously demonstrated to improve the diagnostic accuracy of cellulitis: thermal imaging and the ALT-70 (asymmetry, leukocytosis, tachycardia, age ≥70 years) prediction model. Their contribution reflects the latest step in a quest for improved diagnosis and treatment of cellulitis and reflects both the opportunity and the challenge for clinicians moving forward. In this Editorial, we review the past decade in cellulitis research and identify a path toward improved outcomes for patients.