I agree with the note of caution sounded by Dr
Chosidow and colleagues regarding the use of nonsteroidal anti-inflammatory agents as the sole treatment for cellulitis. Nonetheless, I do not believe that their single-center retrospective study, which purportedly demonstrated an increased risk of necrotizing cellulitis requiring surgical débridement in patients receiving anti-inflammatory agents, provides convincing supportive evidence for their apprehension over the use of anti-inflammatory drugs. The retrospective nature of this study makes it impossible to ensure that all infections treated were of equal severity due to overlapping of affected anatomic sites. We are not told if these patients were treated with appropriate antimicrobial therapy. The failure to control for adrenal corticosteroid use, underlying disease, age, and trauma as an inciting event by logistic regression is also problematic. One must wonder at the validity of comparing the outcome of soft-tissue infection in patients with underlying disease and corticosteroid use with
Sachs MK. Nonsteroidal Anti-inflammatory Drugs in Cellulitis: A Cautionary Note-Reply. Arch Dermatol. 1991;127(12):1845–1846. doi:10.1001/archderm.1991.04520010087018
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