Cellulitis is the inflammation of the skin due to bacteria infection. It commonly affect the legs, fingers and areas with cuts and wounds that are not well cared for.
All layers of the skin are affected in cellulitis and large area is involved compared to Erysipelas where only the superficial layers of the skin are affected.
It affects people of all ages and can be fatal if left untreated.
Causes of Cellulitis
Cellulitis is always caused by bacteria from the environment which enters the skin when its barrier is broken either from a cut or pre-existing skin condition like Eczema.
The most common causative organisms of cellulitis are:
- Staphylococcus Aureus
- Streptococcus species like S.Pyogenes
- Hemophilus Influenze is common in children
- Mycobacterium species in rare cases
Who is at Risk of cellulitis?
There are people who are more likely to develop cellulitis than others based on factors which put them at risk of being infected
- Having open wound either from a cut or recent surgery puts you at risk, it is even riskier if the wound is in the lower limbs
- Weak Immune system: Having medical conditions that weaken the immune system like HIV, Obesity, Cancer, and Diabetes Mellitus.
- Extremes of age: very young and very old are at risk of cellulitis due to their naturally weak immune systems
- Ingrown toenail: It causes trauma repeatedly, breaking the skin barrier
- Pre-existing skin condition: when you have non-infectious skin conditions like Eczema or Psoriasis breaks the skin barrier exposing the inner layers to pathogens.
Symptoms and Signs of Cellulitis
Cellulitis presents as redness of and warmth of the affected area.
It starts in a small point and spread along the limb within few hours. Erythema (redness) is accompanied by severe sharp and burning pain that makes it difficult to sleep. There is swelling (oedema) of the affected limb.
Cellulitis has typical appearance called Peu d’orange skin, which resembles an appearance of an orange. There are no distinct borders of where the infected part ends and normal skin starts, which is another feature that differentiates it from Erysipelas.
Blisters are common in cellulitis, which are a collection of serous fluid between dermis and epidermis.
Diagnosis of cellulitis
The diagnosis of Cellulitis is clinical. It requires careful history and examination. Blood culture is done to determine any systemic spread of the bacteria.
Pus swab collected from pus or blister fluid is important to determine the causative organism in a test called Microscopy, Culture and Sensitivity (M,C&S).
Treatment
Treatment of Cellulitis is oral Antibiotics for mild cases and Intravenous (IV) Antibiotics is reserved for severe cases.
It is also important to also get anti-inflammatories and adequate analgesia since as mentioned before, cellulitis is very painful.
Surgical Incision and Drainage is done if there is pus collection. This is followed by dressing of any open wounds with absorptive dressing if there is oozing.
Antibiotics choices are:
- Cloxacillin 1g IV 6 hourly Or
- FLucloxacillin 500mg oral 6 hourly for 10 days Or
- Cephalexin 500mg oral 6 hourly for 10 days Or
- Levofloxacin 500mg once a day
Complications of Cellulitis
Sometimes cellulitis can complicate if not treated or if there is a delay in treatment. The following complications can occur:
- Septicaemia
- Necrotizing Fasciitis
- Limb loss from wet gangrene
- Contractures
- Chronic pain even after healing.
Prevention
To prevent cellulitis, the most important way is make sure that you keep injuries clean and covered to prevent contamination with dirt and getting infected.
Always check the shoes for any dirt before wearing them if you are Diabetic. This is because the nerves of the feet are damaged by Diabetes decreasing sensation of injury if there is a foreign body in the shoe. If you have been cut by a dirty nail or any object that is dirty, it is important to take antibiotics even before development of cellulitis.
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