ACEP Clinical Policy for Skin and Soft Tissue Infections
Level B recommendation for imaging in suspected necrotizing fasciitis
Level C recommendation for blood cultures in uncomplicated cases
Key evidence sources
Dupuy A et al. Arch Dermatol 1999 — risk factors for erysipelas
OR 23.8 for skin barrier disruption
OR 71.2 for lymphedema
Thomas KS et al. PATCH trial — penicillin prophylaxis for recurrent erysipelas
NNT 6 for penicillin V 250 mg BID prophylaxis
69% reduction in recurrence
Wong CH et al. — LRINEC score development
Score >= 6 PPV 92% and NPV 96%
Adjunct tool for necrotizing fasciitis risk stratification
Coding references
ICD-10 codes
A46 — Erysipelas
Primary ICD-10 code
Applies to classical superficial streptococcal skin infection
M72.6 — Necrotizing fasciitis
Use when necrotizing fasciitis confirmed or suspected
L03 — Cellulitis
For poorly demarcated deeper skin infections
B35.3 — Tinea pedis
Code for identified entry portal
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.