Management of Cellulitis with Corticosteroids

Introduction to Corticosteroid Use

The Infectious Diseases Society of America recommends that systemic corticosteroids may be considered as an optional adjunct in selected non-diabetic adults with uncomplicated cellulitis to potentially shorten healing time by approximately one day 1, 2, 3

A randomized, double-blind, placebo-controlled trial of 108 patients with uncomplicated erysipelas found that the median healing time was shortened by 1 day in the prednisolone group 1, 2
The same trial found that the median IV antibiotic duration was reduced by 1 day in the prednisolone group 1
The hospital stay was shortened by 1 day in the prednisolone group 1
There was no difference in relapse or recurrence at long-term follow-up between the prednisolone and placebo groups 1

The American College of Physicians suggests that appropriate candidates for corticosteroids are non-diabetic adults with uncomplicated cellulitis or erysipelas who are already receiving appropriate antibiotic therapy 1, 2, 3
The guideline recommends that corticosteroids should not be used in diabetic patients, pregnant women, children under 18 years, or patients with systemic toxicity, SIRS, or suspected necrotizing infection 1, 4

The suggested regimen for corticosteroids is prednisone 40 mg daily for 7 days or prednisolone 30 mg daily with an 8-day taper 1, 4

Elevation of the affected extremity is a strongly recommended adjunctive measure that promotes gravity drainage of edema and inflammatory substances 1, 2, 3, 4
Treatment of predisposing conditions, such as tinea pedis, venous eczema, trauma, and toe web abnormalities, is also essential 1, 2, 3, 4

The evidence supporting the use of corticosteroids in cellulitis is weak and limited, based on a single trial from 2005 1, 2, 3

The Infectious Diseases Society of America notes that some have suggested systemic corticosteroid therapy for patients who develop malignant edema, especially of the head and neck, but studies supporting this recommendation are lacking, and airway compromise requiring intubation or tracheostomy may occur with malignant edema 5
Neck location increases risk of airway compromise, making close monitoring mandatory if steroids are used, as suggested by the 2005 IDSA guidelines 5