Cellulitis

Cellulitis is a common, potentially serious bacterial skin infection that affects the deeper layers of the skin and underlying tissues. It typically presents as a red, swollen, warm, and painful area of skin, often accompanied by fever and malaise. Prompt recognition and treatment of cellulitis are crucial to prevent complications such as abscess formation, sepsis, or the spread of infection to other parts of the body. Understanding cellulitis is important for both healthcare providers and the general public to ensure timely diagnosis and effective management.

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Anatomy / Background

The skin is the body’s largest organ and serves as a protective barrier against environmental pathogens. It consists of three main layers:

Epidermis: The outermost layer, providing a waterproof barrier.
Dermis: The middle layer containing connective tissue, blood vessels, and nerves.
Subcutaneous tissue: The deepest layer composed of fat and connective tissue.
Cellulitis involves infection of the dermis and subcutaneous tissues. The infection usually occurs when bacteria enter through a break in the skin, such as a cut, scrape, insect bite, or surgical wound. The most common causative organisms are Streptococcus and Staphylococcus species.

Causes / Etiology

Cellulitis is primarily caused by bacterial invasion of the skin and subcutaneous tissues. Common causes and risk factors include:

  • Bacterial pathogens: Most commonly Streptococcus pyogenes and Staphylococcus aureus (including MRSA strains).
  • Skin trauma: Cuts, abrasions, insect bites, surgical wounds, or ulcers provide entry points for bacteria.
  • Chronic skin conditions: Eczema, athlete’s foot, or psoriasis can compromise skin integrity.
  • Edema or lymphedema: Swelling can impair skin barrier function and immune response.
  • Immunosuppression: Diabetes, cancer, HIV/AIDS, or use of immunosuppressive drugs increase susceptibility.
  • Venous insufficiency: Poor circulation can predispose to infection.
  • Obesity: Associated with increased risk due to skin folds and impaired immunity.

Symptoms / Clinical Presentation

Patients with cellulitis typically present with:

Diagnosis

Diagnosis of cellulitis is primarily clinical, based on history and physical examination. Key diagnostic steps include:

  • Clinical examination: Inspection of the affected area for characteristic signs (redness, swelling, warmth, tenderness).
  • Patient history: Recent trauma, skin breaks, or risk factors.
  • Laboratory tests: Blood tests such as complete blood count (CBC) may show elevated white blood cells indicating infection.
  • Blood cultures: May be taken if systemic infection is suspected.
  • Imaging: Ultrasound or MRI may be used to rule out abscess or deeper infections if the diagnosis is uncertain.
  • Skin cultures: Usually not required unless there is an open wound or abscess.

Treatment Options

Non-Surgical Treatment

  • Antibiotics: The cornerstone of cellulitis treatment. Oral antibiotics targeting Streptococcus and Staphylococcus species are typically prescribed. Common choices include cephalexin, dicloxacillin, or clindamycin. For MRSA risk, agents like trimethoprim-sulfamethoxazole or doxycycline may be used.
  • Supportive care: Elevation of the affected limb to reduce swelling, pain management with analgesics, and hydration.
  • Wound care: Proper cleaning and dressing of any skin breaks.

Surgical Treatment

Surgery is generally not required for uncomplicated cellulitis but may be necessary if:

  • An abscess forms requiring drainage.
  • Necrotizing fasciitis (a rapidly spreading infection) is suspected.
  • There is failure to respond to antibiotic therapy.

Procedure Details (if surgical or procedural)

Postoperative Care / Rehabilitation

Risks and Complications

Prognosis

With prompt and appropriate treatment, cellulitis usually resolves without long-term problems. Most patients recover fully within 7 to 10 days. However, delayed treatment or underlying health issues can lead to complications and prolonged recovery.

When to See a Doctor

Seek medical attention if you experience:

  • Rapidly spreading redness, swelling, or pain.
  • Fever, chills, or other systemic symptoms.
  • Signs of abscess such as fluctuance or pus.
  • Red streaks extending from the infected area.
  • Failure to improve or worsening symptoms despite treatment.
  • Recurrent episodes of cellulitis.

Early evaluation by a healthcare professional is essential to prevent serious complications.

Conclusion

Cellulitis is a common bacterial skin infection that requires timely diagnosis and treatment to avoid complications. Understanding its causes, symptoms, and management options empowers patients and caregivers to seek appropriate care promptly. If you suspect cellulitis, consult a healthcare provider for evaluation and treatment to ensure the best possible outcome.

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