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Impetigo vs. Cellulitis: Differentiating Skin Infections

Both are bacterial skin infections but differ in depth, presentation, and management urgency.

Impetigo (Superficial)

Pathogens: S. aureus (bullous/non-bullous), S. pyogenes (non-bullous)
Layers: Epidermis only (stratum corneum)
Presentation: Honey-colored crusts (non-bullous); flaccid bullae → collarette scale (bullous)
Site: Face (perioral, nares), extremities; exposed areas
Contagiousness: High (direct contact, fomites)
Systemic symptoms: Rare (unless extensive)

Cellulitis (Deep)

Pathogens: S. pyogenes (β-hemolytic strep), S. aureus (including MRSA)
Layers: Dermis + subcutaneous tissue
Presentation: Erythema, warmth, swelling, pain; advancing margins; ± lymphangitic streaks, lymphadenopathy
Site: Lower legs > arms > face
Portal: Skin break (trauma, tinea pedis, ulcer, insect bite)
Systemic: Fever, chills, leukocytosis common

Key Differentiators

Treatment

Impetigo: Mupirocin 2% or retapamulin 1% BID ×5d (localized); oral cephalexin/dicloxacillin ×7d (extensive/bullous)
Cellulitis: Cephalexin 500mg QID ×5-7d (mild); add MRSA coverage (TMP-SMX, doxycycline, clindamycin) if purulent/risk factors; IV for severe (cefazolin, vancomycin if MRSA)
Adjuncts: Elevation, compression (if venous stasis), wound care

Complications

Impetigo: Post-strep glomerulonephritis (nephritogenic strains), scarring (ecthyma)
Cellulitis: Abscess, necrotizing fasciitis, sepsis, bacteremia, recurrent episodes (lymphatic damage)

Prevention

Skin hygiene, prompt wound care
Treat tinea pedis (portal for leg cellulitis)
Compression for venous insufficiency
Decolonization (mupirocin intranasal + chlorhexidine washes) for recurrent S. aureus

Iridology - Related Articles

Feature	Impetigo	Cellulitis
Depth	Epidermal	Dermal/subcutaneous
Texture	Crusted, superficial	Indurated, deep
Margins	Discrete	Indistinct, advancing
Pain	Mild	Moderate-severe
Systemic signs	Rare	Common
Treatment	Topical antibiotics	Systemic antibiotics