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Diagnosis

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

The diagnosis of necrotising fasciitis is overridingly clinical. There must be low threshold for diagnosis if the following features are present:

  • skin changes:
    • erythema
    • low-grade cellulitis
    • cyanotic discolouration or ecchymosis
    • epidermolysis or bullae
    • skin necrosis
    • anaesthesia of skin beyond the margin of surface colour change
    • crepitus
  • a hard, indurated feel to the subcutaneous tissue which is present beyond the visible limits of skin involvement
  • pain out of proportion to the visible surface changes
  • signs of systemic toxicity with altered mental status, fever, shock or acute renal failure
  • minimal improvement despite initial antibiotic therapy

A number of blood investigations may support the diagnosis. Imaging should not delay the patient progressing to theatre for rapid, adequate debridement.

Reference:

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