Clinical criteria and risk factors.

Necrotizing cellulitis and fasciitis may be difficult to recognize. When sk in necrosis is not obvious, the diagnosis must be suspected if there are si gns of severe sepsis (accelerated heart or respiratory rates, oliguria, men tal confusion...) and/or some of the following local symptoms or signs: sev ere spontaneous pain, indurated edema, bullae, cyanosis, skin pallor; absen ce of lymphangitis, skin hypoesthesia, crepitation, muscle weakness, foul s mell of exudates. Many risk factors are suspected. A recent case-control st udy demonstrated that using ibuprofen increased the risk of cellulitis comp licating chickenpox in children. Evidence is lower for other risk factors t hat are present with a high prevalence in most series: local lesion of skin or mucous membranes (acute or chronic disease, traumatism, surgery..), dia betes, arteriopathy, alcoholism, obesity, immunosuppression, NSAIDs. The ri sk of streptococcal necrotizing fasciitis is increased when in contact with patients infected by the same streptococcus. (C) 2000 Editions scientifiqu es et medicales Elsevier SAS.