When to Suspect Necrotizing Fasciitis

Use this ABCDE mnemonic to distinguish necrotizing fasciitis, which usually requires surgery, from cellulitis, which can be treated with antibiotics alone:

Adenitis (also lymphangitis).
Bullae.
Crepitus.
Dishwater-colored fluid discharge.
Edema greater than erythema.

Other signs of necrotizing fasciitis include compartments that are not soft, rapid progression of symptoms, severe pain, laboratory abnormalities (such as those associated with early disseminated intravascular coagulation, an elevated creatine kinase level, or a low bicarbonate level), and a sickly appearance. Plain radiographs to detect subcutaneous gas and CT of the affected and unaffected side to detect asymmetry can also be helpful.

-- D. Brady Pregerson, MD
         Los Angeles
 

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