penicillinase-resistant penicillin, first-generation cephalosporin, amoxicillin-clavulanate (Augmentin), macrolide, or fluoroquinolone (adults only) is appropriate.5 Limited disease can be treated orally, but more extensive disease requires parenteral therapy. Marking the margins of erythema with ink is helpful in following the progression or regression of cellulitis (Figure 2). Outpatient therapy with injected ceftriaxone (Rocephin) provides 24 hours of parenteral coverage and may be an option for some patients. The patient should be seen the following day to reassess disease progression.Inked margins of cellulitis. Most cases of superficial cellulitis improve within one day, but patients who exhibit thickening of the dermis usually take several days of parenteral antibiotics before significant improvement occurs. Antibiotics should be maintained for at least three days after the resolution of acute inflammation.5 Adjunctive therapy includes the following: cool compresses; appropriate analgesics for pain; tetanus immunization; and immobilization and elevation of the affected extremity.6 A parenteral second- or third-generation cephalosporin (with or without an aminoglycoside) should be considered in patients who have diabetes, immunocompromised patients, those with unresponsive infections, or in young children.5 The patient may also require a plain radiograph of the area or surgical debridement to evaluate for gas gangrene, osteomyelitis, or necrotizing fasciitis.6 Recurrent episodes of cellulitis or undergoing surgery, such as mastectomy with lymph node dissection, can compromise venous or lymphatic circulation and cause dermal fibrosis, lymphedema, epidermal thickening, and repeated episodes of cellulitis. These patients may benefit from prophylaxis with erythromycin, penicillin, or clindamycin (Cleocin).5,7 Periorbital cellulitis is caused by the same organisms that cause other forms of cellulitis and is treated with warm soaks, oral antibiotics, and close follow-up.8 Children with periorbital or orbital cellulitis often have underlying sinusitis.9 If the child is febrile and appears toxic, blood cultures should be performed and lumbar puncture considered. Haemophilus influenzae type b (Hib) in young children was a significant concern until the widespread use of the Hib vaccine and coverage with a parenteral third-generation cephalosporin was used routinely. Recently, some researchers have recommended no longer routinely covering for H. influenzae.8–10 Orbital cellulitis occurs when the infection passes the orbital septum and is manifested by proptosis, orbital pain, restricted eye movement, visual disturbances, and concomitant sinusitis. Complications include abscess formation, persistent blindness, limited eye movement, diplopia, and, rarely, meningitis.11 This ocular emergency requires intravenous antibiotics, otorhinolaryngology, and ophthalmologic consultation.12 Perianal cellulitis is caused by group A beta-hemolytic streptococcal infection and occurs most often in children. A study13 of children with perianal cellulitis found a mean age of onset of 4.25 years. Ninety percent of patients presented with dermatitis, 78 percent with itching, 52 percent with rectal pain, and 35 percent with blood-streaked stools. Despite 10 days of oral antibiotics (primarily penicillin or erythromycin), the recurrence rate was high at 39 percent. If there is recurrence, the presence of an abscess should be considered, with needle aspiration of the site for bacteriology being more accurate than a skin swab.14 Erysipelas Erysipelas also known as St. Anthony's fire, usually presents as an intensely erythematous infection with clearly demarcated raised margins, and often with associated lymphatic streaking (Table 1). Common sites are the legs and face.15 Most cases do not have an inciting wound or skin lesion and are preceded by influenza-like symptoms. The incidence of erysipelas is rising, especially in young children, the elderly, persons with diabetes, alcoholic persons, and patients with compromised immune systems or lymphedema. Erysipelas is caused almost exclusively by beta-hemolytic streptococcus and thus can be treated with standard dosages of oral or intravenous penicillin. However, most physicians