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Swelling of the affected area
Rashes
Red blotches on the skin
Hot skin
Redness of the skin
Pain in the arm
Swollen feet
Not seeing your symptoms? No worries!
A bacterial skin infection, cellulitis occurs when bacteria invade the skin through a tear, which can be caused by insect bites, wounds, or scratching. People with diabetes and weakened immune systems have a higher risk.
Your doctor may ask these questions to check for this disease:
Most cases can be treated with antibiotic pills, but if unresponsive, stronger injectable antibiotics may be needed. Painkillers and antihistamines can help relieve symptoms.
Reviewed By:
Saqib Baig, MD, MS (Pulmonology, Critical Care, Internal Medicine)
Dr. Baig graduated from Army Medical College (NUST) Pakistan in 2007. He did his internal medicine training from Baltimore, Maryland, USA during the years 2009-2013. He joined the internal medicine faculty practice at Medical College of Wisconsin in USA for 2 years before pursuing advanced training. He completed his pulmonary disease and critical care medicine fellowship from Rutgers Robert Wood Johnson Medical School from 2015-2018. | | During his fellowship, Dr. Baig completed his master's in health care services management through Rutgers Business School. He currently serves as the medical director of respiratory therapy and pulmonary function lab and the clinical director of the COPD program at the Jane and Leonard Korman Respiratory Institute at Thomas Jefferson University. He holds the Assistant Professor of Medicine rank at Sidney Kimmel Medical College at Thomas Jefferson University. Dr. Baig's interests lie in respiratory physiology, airways disease, and data science.
Yukiko Ueda, MD (Dermatology)
Dr. Ueda graduated from the Niigata University School of Medicine and trained at the University of Tokyo Medical School. She is currently a clinical assistant professor at the Department of Dermatology, Jichi Medical University, and holds several posts in the dermatology departments at Kyoto Prefectural University of Medicine, Komagome Hospital, University of Tokyo, and the Medical Center of Japan Red Cross Society.
Content updated on Feb 13, 2025
Following the Medical Content Editorial Policy
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Q.
Is That Skin Sore Infected? Why Staphylococcus Spreads and Medically Approved Next Steps
A.
There are several factors to consider. Spreading redness, warmth, swelling, tenderness, pus, or fever can signal a staph skin infection, which spreads easily through small skin breaks, direct contact, and shared items, especially when the skin barrier or immune system is weakened. Medically approved next steps include gentle washing, covering the sore, warm compresses for small boils, avoiding squeezing, and prompt medical evaluation for spreading pain, fever, red streaks, facial involvement, diabetes, or immune compromise; see below for complete guidance, including when urgent care is needed and how drainage, cultures, and antibiotics are used.
References:
* Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL, Hirschmann JV, Kaplan SL, Montoya AS, Wade JC; Infectious Diseases Society of America. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014 Jul 15;59(2):e10-52. doi: 10.1093/cid/ciu296. Erratum in: Clin Infect Dis. 2015 Apr 1;60(7):1135. PMID: 24979140.
* Krismer B, Unger MM, Brötz-Oesterhelt H, Peschel A. Pathogenesis of Staphylococcus aureus Skin Infections. Trends Microbiol. 2018 Mar;26(3):260-272. doi: 10.1016/j.tim.2017.11.006. Epub 2017 Dec 23. PMID: 29329864.
* Roxborough A. Diagnosis and management of common bacterial skin infections in primary care. Practitioner. 2022 Jan;266(1814):11-14. PMID: 35133642.
* Klevens RM, Lee R, Sievert DM, Perencevich EN, Weinstein RA, Gorwitz RJ, Jernigan JA. Staphylococcus aureus and Methicillin-Resistant Staphylococcus aureus Infections. Infect Dis Clin North Am. 2014 Dec;28(4):595-611. doi: 10.1016/j.idc.2014.08.003. PMID: 25239276.
* Liu C. Skin and soft tissue infections caused by Staphylococcus aureus. Clin Dermatol. 2015 Nov-Dec;33(6):613-20. doi: 10.1016/j.clindermatol.2015.05.006. Epub 2015 May 27. PMID: 26570682.
Q.
Is Your MRSA Infection Not Healing? The Reality & Medically Approved Next Steps
A.
If your MRSA infection is not improving within 48 to 72 hours or is worsening, common reasons include the wrong antibiotic, an abscess that needs drainage, spreading cellulitis, underlying conditions, or reinfection, and urgent signs like fever or rapidly spreading redness require immediate care. Medically approved next steps include prompt reevaluation with culture and possible drainage or antibiotic change, completing all prescribed meds, meticulous wound care and home hygiene, and considering decolonization for recurrences; there are several factors to consider, so see the complete guidance below.
References:
* Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ, Kaplan JM, Karchmer AL, Levine RP, Murray BE, J. Rybak MJ, Talan DE, Lipman TL, Skolnik PK, Wagner K, Sevenler D, Spellberg B, Ticehurst JR, Chambers HF, Fowler VG Jr, Franco-Paredes C, Kanj SS, Marra AR, O'Horo JC, Parvizi J, Rolston K, Saravolatz LD, Saag MS, Sarin R. Management of Persistent Methicillin-Resistant Staphylococcus aureus Bacteremia. Clin Infect Dis. 2017 Jan 15;64(2):212-219. doi: 10.1093/cid/ciw700. PMID: 27742721.
* Gorwitz RJ. Strategies for the management of recurrent MRSA infections. Semin Cutan Med Surg. 2011 Sep;30(3):142-8. doi: 10.1016/j.sder.2011.05.006. PMID: 21962495.
* Kanj SS, Fowler VG Jr. Treatment Failure in Methicillin-Resistant Staphylococcus aureus Bacteremia: An Update. Curr Infect Dis Rep. 2017 Nov 6;19(12):50. doi: 10.1007/s11908-017-0604-x. PMID: 29110196.
* Pankey GA, Bell JG. Management of Refractory Skin and Soft Tissue Infections. Infect Dis Clin North Am. 2017 Mar;31(1):21-34. doi: 10.1016/j.idc.2016.10.003. PMID: 28153177.
* Bassetti M, Righi E, Tagliaferri E, Fasciana T, Tascini C. Recent advances in the treatment of complicated skin and soft tissue infections due to MRSA. Expert Opin Pharmacother. 2017 Dec;18(17):1851-1863. doi: 10.1080/14656566.2017.1400275. PMID: 29083329.
Q.
Infection Not Healing? Why Cephalexin Is Used & Your Medical Next Steps
A.
Cephalexin is a commonly used antibiotic for bacterial infections, especially skin infections like cellulitis, and most people should notice improvement within 2 to 5 days if taken exactly as prescribed. If symptoms are not improving or are worsening, possible reasons include antibiotic resistance, a non-bacterial cause, a deeper infection or abscess, underlying health issues, or dosing problems; you may need cultures, imaging, a change in antibiotics, or drainage. There are several factors to consider and important red flags for when to seek urgent care; see below for the complete guidance and next steps.
References:
* Sader HS, Stilwell MG, Dowzicky MJ, Pfaller MA, Jones RN. Pharmacologic Management of Skin and Soft-Tissue Infections with Oral Cephalexin. Infect Dis Clin Pract. 2018 Sep;26(5):252-257. doi: 10.1097/IPC.0000000000000627. Epub 2018 Jun 29. PMID: 30166779.
* Pietrangeli G, Borzì G, Boccadoro S, De Simone A, De Luca V, Del Prete F, Del Porto F, De Vito R. Persistent or recurrent skin and soft tissue infections: when to suspect underlying immunodeficiency. Curr Opin Infect Dis. 2019 Apr;32(2):123-128. doi: 10.1097/QCO.0000000000000523. PMID: 30946280.
* Muthulingam A, Hsieh YC, Dhand A. Current challenges and future directions in the management of skin and soft tissue infections. Ther Adv Infect Dis. 2023 Aug 24;10:20499361231194269. doi: 10.1177/20499361231194269. PMID: 37637887; PMCID: PMC10452396.
* Ribeiro J, Cua B, Puzio T, Patel D, Strymish J, Lawler J, O'Reilly A, Gupta K, Branch-Elliman W. Antibiotic Stewardship for Skin and Soft Tissue Infections. Clin Infect Dis. 2020 Jan 22;70(3):474-482. doi: 10.1093/cid/ciz216. PMID: 31969966.
* Spellberg B, Shrestha NK, Corey GR. Strategies to combat antimicrobial resistance in skin and soft tissue infections. Lancet Infect Dis. 2021 Mar;21(3):e75-e83. doi: 10.1016/S1473-3099(20)30501-1. Epub 2020 Sep 28. PMID: 33647432.
Q.
Is it a Staph Infection? Why Your Skin is Swelling and Medical Next Steps
A.
Skin swelling from a possible staph infection usually shows redness, warmth, tenderness, and sometimes pus or a boil. Seek medical care if redness spreads quickly, pain is severe, the face is involved, fever or chills occur, drainage worsens, or there is no improvement in 48 hours, and seek emergency help for high fever, rapid heart rate, confusion, or trouble breathing. There are several factors to consider, including other causes like allergic reactions or fungal infections, MRSA, personal risk factors, and the right do's and don'ts; see the complete guidance below to choose the safest next steps for your care.
References:
* Lo, B., & Solomon, D. A. (2020). Staphylococcus aureus Skin and Soft Tissue Infections. *Current Opinion in Infectious Diseases*, *33*(4), 304–309.
* Stevens, D. L., & Bryant, A. E. (2021). Cellulitis and Skin Abscesses: A Review. *JAMA*, *325*(8), 773–782.
* May, D. A., & Blevins, D. P. (2022). Management of Skin and Soft Tissue Infections. *Infectious Disease Clinics of North America*, *36*(4), 843–864.
* May, A. E., & Davies, B. (2020). Cellulitis and related skin infections: current insights into pathogenesis and treatment. *Journal of Medical Microbiology*, *69*(4), 541–551.
* Miller, S., & Lo, T. (2021). Skin and Soft Tissue Infections. *American Family Physician*, *103*(12), 738–747.
Q.
Is it MRSA? Why your skin won’t heal and the medical steps to take.
A.
There are several factors to consider when a skin sore will not heal: MRSA is possible if the area is red, swollen, warm, rapidly enlarging, painful, and draining pus, sometimes with fever, but only a clinician exam and a wound culture can confirm it. Next steps include prompt medical evaluation for possible drainage and the right antibiotic, keeping the wound clean and covered, and preventing spread with good hygiene; see the complete guidance below for urgent red flags, who is at higher risk, and how look-alikes like cellulitis can change the care you need.
References:
* Spellberg, B., & J. (2015). Diagnosis and management of skin and soft tissue infections caused by MRSA. *Infectious Disease Clinics of North America*, *29*(3), 517-532.
* O'Donnell, K. L., & Boyle, K. (2020). Management of non-healing wounds: A comprehensive review. *Advances in Skin & Wound Care*, *33*(9), 466-476.
* Wozniak, P. S., & O'Horo, J. C. (2021). Management of Skin and Soft Tissue Infections. *Infectious Disease Clinics of North America*, *35*(2), 481-499.
* Jenkins, K., & Moran, G. J. (2018). Recurrent skin and soft tissue infections: an update on diagnosis and management. *Current Opinion in Infectious Diseases*, *31*(4), 304-309.
* David, M. Z., & Cadman, E. T. (2019). Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) skin and soft tissue infections: a concise review. *Clinical Microbiology Reviews*, *32*(4), e00057-19.
Q.
Red, Painful Skin? Why Your Leg is Swelling & Medical Next Steps
A.
Red, warm, swollen, painful skin on one leg is most often cellulitis, a bacterial infection that needs prompt medical evaluation and antibiotics, and you should seek urgent care if redness is rapidly spreading, you have fever or severe pain, or you notice red streaks, numbness, blisters, or blackened skin. There are several factors to consider, including other possible causes like blood clots, venous disease, eczema, or gout and how quickly to act; see below for complete details on symptoms, risks, diagnosis, treatment, home care, prevention, and exact next steps.
References:
* Delle Monache M, et al. The acute unilateral painful red swollen leg: diagnostic algorithm. Intern Emerg Med. 2019 Jun;14(4):659-668.
* O'Brien N, et al. Unilateral Leg Swelling: A Diagnostic Challenge. Am Fam Physician. 2020 Jan 1;101(1):31-38.
* Raff AB, Kroshinsky D. Cellulitis: A Review. JAMA. 2016 Oct 18;316(14):1478-1490.
* Di Minno MN, et al. D-dimer testing in patients with suspected deep vein thrombosis: a systematic review. J Thromb Haemost. 2021 Mar;19(3):772-785.
* Doughty A, et al. Clinical Assessment of Acute Leg Swelling. West J Emerg Med. 2018 Jan;19(1):154-164.
Q.
Skin Not Healing? Why Mupirocin Works & Medically Approved Next Steps
A.
Skin not healing? Mupirocin is a targeted, FDA approved topical antibiotic that treats many small, localized bacterial skin infections like impetigo by blocking staph and strep growth so your body can resume healing. There are several factors to consider and red flags that mean mupirocin may not be enough, plus medically approved next steps like when to get a culture, start oral antibiotics, check blood sugar, optimize wound care, and seek urgent care if needed. See complete details below.
References:
* Miller MA, Giger M. Topical Mupirocin for Skin Infections. Dermatol Ther. 2015 May-Jun;28(3):144-8. doi: 10.1111/dth.12204. PMID: 25777771.
* Pastar I, Nusbaum AG, Perez Perez L, Patel N, Chen V, O'Malley M, Stojadinovic O, Stone RC, Schultz GS, Davis SC, Tomic-Canic M. Bacterial Biofilms in Chronic Wounds. Adv Wound Care (New Rochelle). 2017 Sep 1;6(9):369-378. doi: 10.1089/wound.2016.0768. PMID: 28974533; PMCID: PMC5610052.
* Loeffelholz MJ, Reboli AC. Wound infection and the development of antimicrobial resistance: risk factors and strategies for prevention. Curr Opin Infect Dis. 2022 Feb 1;35(1):77-84. doi: 10.1097/QCO.0000000000000799. PMID: 34842777.
* Schultz G, Vowden P, Vowden K. Topical antimicrobial therapy in wound care: a practical guide. J Wound Care. 2022 Feb 2;31(2):78-87. doi: 10.12968/jowc.2022.31.2.78. PMID: 35149303.
* Vowden P, Vowden K, Al-Khazraji M, Al-Ansari A. The management of chronic wounds: A multidisciplinary approach. J Clin Pharm Ther. 2023 Mar;48(2):162-177. doi: 10.1111/jcpt.13783. Epub 2022 Dec 31. PMID: 36611202.
Q.
Skin Infection Spreading? Why You Need Mupirocin and Your Medical Next Steps
A.
If a skin infection is spreading, mupirocin is a prescription topical antibiotic that helps only with small, superficial bacterial infections like impetigo or minor staph, while deeper or rapidly worsening cases may need oral antibiotics and urgent evaluation for cellulitis. Watch for red flags such as rapidly expanding redness, warmth, pus, fever, red streaks, severe pain, or facial involvement and seek care promptly; use mupirocin only if prescribed and exactly as directed. There are several factors to consider; see the complete guidance below for when mupirocin is appropriate, how to use it, what to avoid, and the precise next steps in your care.
References:
* Patel RB, Shah S, Chaurasia N. Mupirocin for the treatment of skin and soft tissue infections. Clin Cosmet Investig Dermatol. 2018 Dec 10;11:645-649. doi: 10.2147/CCID.S184852. PMID: 30584347; PMCID: PMC6296184.
* Goldstein EJC, Citron DM, Nesbit CA. Diagnosis and Management of Skin and Soft Tissue Infections: A Review. JAMA. 2021 Sep 14;326(10):959-973. doi: 10.1001/jama.2021.11977. PMID: 34524458.
* Mahalingam G, Van Dijl JM, Singh S. Mupirocin resistance in Staphylococcus aureus: A narrative review. J Glob Antimicrob Resist. 2022 Dec;31:376-384. doi: 10.1016/j.jgar.2022.11.006. Epub 2022 Nov 10. PMID: 36368412.
* Mayes T, Le Saux N. Management of impetigo: a review. Eur J Pediatr. 2021 May;180(5):1377-1385. doi: 10.1007/s00431-020-03893-w. Epub 2020 Dec 21. PMID: 33345100.
* Linder KA, Pasternack MS. Topical and systemic antimicrobial agents in the treatment of superficial bacterial skin infections. Curr Opin Infect Dis. 2019 Apr;32(2):106-112. doi: 10.1097/QCO.0000000000000523. PMID: 30601170.
Q.
Is it a Bite? Why Your Skin is "Angry" and Medically-Proven MRSA Steps
A.
Red, swollen, painful "angry skin" that looks like a bite is often a staph infection, including MRSA, not an insect bite; key clues are pain more than itch, rapid growth over 24 to 48 hours, warmth or firmness, pus, fever, or a more diffuse spread that suggests cellulitis. Medically proven steps are to avoid squeezing, keep it clean and covered, track changes, and seek prompt care for possible drainage and the right antibiotics, with urgent evaluation for fever, red streaks, severe pain, or feeling unwell; there are several factors to consider, and the complete, step-by-step guidance and prevention tips are detailed below.
References:
* Miller, L. G., & Kaplan, S. L. (2021). Methicillin-resistant *Staphylococcus aureus* (MRSA) infections in children and adults. *Lancet*, *398*(10299), 500–512.
* Talan, D. A., & Salmi, D. A. (2020). Management of Skin and Soft Tissue Infections. *Infectious Disease Clinics of North America*, *34*(4), 743–764.
* See, I., & Dantes, R. (2020). Community-Associated Methicillin-Resistant Staphylococcus aureus: An Update for the Clinician. *Clinical Infectious Diseases*, *71*(Supplement_1), S101–S107.
* Bassetti, M., Righi, E., & Peghin, M. (2019). Clinical Management of Skin and Soft Tissue Infections. *Current Treatment Options in Infectious Diseases*, *11*(4), 223–236.
* Spaan, A. N., van Strijp, J. A. G., & de Haas, C. J. C. (2017). Staphylococcus aureus virulence factors: A historical perspective. *FEMS Microbiology Reviews*, *41*(4), 407–421.
Q.
Cellulitis in Women 30-45: Symptoms, Risks & Vital Next Steps
A.
Cellulitis is a bacterial skin infection that can affect women 30 to 45, starting with spreading redness, warmth, swelling, and pain, sometimes with fever; prompt antibiotics with rest and elevation usually lead to recovery, but seek urgent care for rapid spread, severe pain, red streaks, or high fever. There are several factors to consider. See below for key risks like shaving, pedicures, eczema, athlete’s foot, diabetes, obesity, pregnancy-related swelling, and immune issues, plus what to expect from diagnosis, full treatment timelines, home care, prevention, and exactly when to seek immediate help.
References:
* Bonaventura M, Perini G, Cozzani E, Parodi A. Cellulitis. An Update. J Clin Med. 2022 Aug 10;11(16):4678. doi: 10.3390/jcm11164678. PMID: 36012015; PMCID: PMC9409894.
* Kofteridis DP, Katsikarchos A, Kofteridis V, Drosos R, Lagoudianakis E, Dalianas A, Bampalis VG, Christoforaki D, Pitsiava D, Ioannidis A, Alexandri P, Kontou M, Papadimitrakis I, Vlachogiannis I, Samonis G, Tsapras N. Clinical features and predictors of severity in adult patients with cellulitis: A multicenter study. J Clin Med. 2022 Jul 28;11(15):4416. doi: 10.3390/jcm11154416. PMID: 35921607; PMCID: PMC9369974.
* Ohyama N, Horiuchi Y, Tamashiro T, Kikuchi H, Kitamura Y, Shiohira K, Nago N, Arakaki K, Shimabukuro M. Risk factors for recurrent cellulitis: a systematic review and meta-analysis. J Dermatol. 2019 Oct;46(10):921-931. doi: 10.1111/1346-8138.14984. Epub 2019 Jul 23. PMID: 31336044.
* Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL, Hirschmann JF, Kaplan SL, Montoya JG, Nadeau D, Phair JP, Rollin DF, Talan DA, Wexler H. Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2014 Jul 15;59(2):e10-52. doi: 10.1093/cid/ciu296. Epub 2014 Jun 25. PMID: 24973418.
* Weng QY, Raff AB, Cohen JM, Sox HC, Korvec M, Raff H, Raff AC. Not all leg swelling is cellulitis: a prospective study of diagnostic accuracy for lower extremity cellulitis. J Hosp Med. 2011 Oct;6(8):482-6. doi: 10.1002/jhm.911. Epub 2011 May 26. PMID: 21628103.
Q.
Cellulitis in Women 65+: Warning Signs You Should Never Ignore
A.
Women 65 and older should seek prompt care for cellulitis if they notice spreading redness, warmth, swelling, tenderness or pain, fever or chills, red streaks, severe pain out of proportion, confusion or weakness, numbness or tingling, or skin that turns purple, gray, or blisters. There are several factors to consider, including why older adults are at higher risk, common triggers, what worsening symptoms mean, and how treatment and prevention work; see the complete details below to understand more and decide the right next steps.
References:
* Quagliano PV, Khan H, Patel M, et al. Cellulitis: A Practical Update on Diagnostics, Treatment, and Prevention. Am J Med. 2023 Apr;136(4):379-386. doi: 10.1016/j.amjmed.2022.11.002. Epub 2022 Nov 19. PMID: 36413988.
* Mitzner MC, Lee A, Patel S, et al. Skin and soft tissue infections in older adults: an overview. Curr Opin Infect Dis. 2022 Dec 22;35(6):533-539. doi: 10.1097/QCO.0000000000000889. PMID: 36458512.
* Advincula K, Ko D, Khavari N. Atypical Presentations of Common Dermatologic Conditions in Older Adults. J Am Acad Dermatol. 2023 Nov;89(5):1041-1051. doi: 10.1016/j.jaad.2023.03.003. Epub 2023 Mar 7. PMID: 36906233.
* Halilaj A, Kanzler B, Kanzler S, et al. Recurrent cellulitis of the leg: a review of current management strategies. J Eur Acad Dermatol Venereol. 2023 Feb;37(2):292-300. doi: 10.1111/jdv.18567. Epub 2022 Oct 26. PMID: 36284641.
* Stevens DL, Bryant AE, Goldstein EJC. Cellulitis: A Comprehensive Review. N Engl J Med. 2022 Oct 27;387(17):1599-1608. doi: 10.1056/NEJMra2116037. PMID: 36300438.
Q.
Can I use topical and oral antibiotics together?
A.
Yes, you can use topical and oral antibiotics together, especially for treating acne, as they can work better when combined. See below to understand more.
References:
Del Rosso JQ. (2016). Topical and oral antibiotics for acne vulgaris. Seminars in cutaneous medicine and surgery, 27416309.
https://pubmed.ncbi.nlm.nih.gov/27416309/
Thiboutot DM, Shalita AR, Yamauchi PS, Dawson C, Arsonnaud S, Kang S, & Differin Study Group. (2005). Combination therapy with adapalene gel 0.1% and .... Skinmed, 15891249.
https://pubmed.ncbi.nlm.nih.gov/15891249/
Zaenglein AL, Shamban A, Webster G, Del Rosso J, Dover JS, Swinyer L, et al. (2013). A phase IV, open-label study evaluating the use of triple- .... Journal of drugs in dermatology : JDD, 23839176.
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https://www.medrxiv.org/content/10.1101/2024.08.29.24312810v1Wilcox, M. H., & Dryden, M. (2021). Update on the epidemiology of healthcare-acquired bacterial infections: focus on complicated skin and skin structure infections. Journal of Antimicrobial Chemotherapy.
https://academic.oup.com/jac/article-abstract/76/Supplement_4/iv2/6437934Ren, Z., & Silverberg, J. I. (2020). Association of atopic dermatitis with bacterial, fungal, viral, and sexually transmitted skin infections. Dermatitis.
https://www.liebertpub.com/doi/abs/10.1097/DER.0000000000000526Ramakrishnan, K., Salinas, R. C., & Higuita, N. I. A. (2015). Skin and soft tissue infections. American Family Physician.
https://www.aafp.org/pubs/afp/issues/2015/0915/p474.html