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CELLULITIS

Cellulitis is a common and severe bacterial infection that affects the superficial and deep layers of the skin. It occurs when bacteria enter a break in the skin and spreads. It causes skin inflammation which is characterised by swelling, warmth, redness and tenderness of the skin. Cellulitis is usually painful and can spread rapidly to other parts of the body.

Cellulitis may occur anywhere in the body and the face. However, the most commonly affected region is the lower leg, particularly the shinbone and foot. A person with cellulitis may also develop fever and swollen lymph nodes around the infected area.

The types of cellulitis are classified based on the location of infection such as

  • Periorbital and Orbital Cellulitis: Cellulitis that occurs in the area around the eye socket
  • Buccal Cellulitis: Cellulitis that occurs in the area around cheek
  • Facial Cellulitis: Cellulitis that occurs in the face
  • Perianal Cellulitis: Cellulitis that occurs in the area around the anal orifice

Signs and Symptoms

The following are the signs and symptoms associated with cellulitis

  • Redness, warmth, pain and tenderness in the affected area
  • Glossy and swollen appearance of the skin in the affected area
  • Blisters which may leak yellow, clear fluid or pus
  • Fever

 

If the cellulitis becomes severe, it may cause additional symptoms such as: 

  • Chills
  • Fatigue
  • Dizziness
  • Muscle aches
  • Sweating
  • Shivering

Causes

Cellulitis is commonly caused by Staphylococcus and Streptococcus bacteria. Cellulitis commonly occurs due to:

  1. Cuts or puncture wounds
  2. Infected surgical wounds
  3. Insect bites or spider bites
  4. Chronic skin conditions such as eczema or psoriasis
  5. Underlying bone infection(osteomyelitis)

Risk Factors

Certain factors may increase the susceptibility of an individual to develop cellulitis:

  • Skin Injury: Cuts, fracture, burns or scrapes
  • Diabetes
  • Circulatory problems such as varicose veins and lymphedema
  • Liver conditions: Hepatitis and cirrhosis
  • Weakened Immune System: Secondary to infections such as HIV, leukemia and certain medications like corticosteroids may weaken the immune system.
  • Skin Conditions: Eczema, athlete’s foot, shingles and chickenpox
  • Intravenous Drug Use
  • Radiation therapy and Chemotherapy

Possible Complications

The following are the potential complications of cellulitis:

  • Blood infection
  • Bone infection
  • Inflammation of lymph vessels
  • Tissue death or gangrene
  • Infection of lining of the fascia 

Diagnosis

Usually no workup is required in uncomplicated cases of cellulitis. The following diagnostic tests may be required in serious conditions:

  • Blood culture or wound culture is done to identify the causative organism for cellulitis.
  • Complete blood count is done to measure the components of blood. Alterations in the levels of the blood components may be caused due to conditions such as anemia, infection or leukemia. Blood test is also done to check for the levels of C-reactive protein. High levels indicate inflammation.
  • Ultrasonography is helpful to detect the presence occult abscess.

Treatment

Treatment is based on the condition of the infection. Usually, antibiotics are given orally for a week to 14 days. Your doctor would administer intravenous or intramuscular antibiotics if:

  1. Your infection is severe.
  2. You have pre-existing health condition.
  3. Your infection has worsened after taking oral antibiotics for two to three days.

In very rare cases, surgery may be required to open and drain abscess that has collected in the tissue. Some common antibiotics which are prescribed to treat cellulitis are:

  • Penicillin
  • Amoxicillin
  • Cefazolin
  • Azithromycin
  • Ceftriaxone

Prevention

The following precautions prevent development of cellulitis in the skin wounds:

  • Washing the wound regularly
  • Applying an antiseptic ointment after cleaning the wound
  • Covering the wound with bandage
  • Watching for signs of infection

People with diabetes and with poor circulation should take extra precautions to prevent the skin injury. Some skin care measures include

  • Moisturise the skin regularly
  • Protect hands and feet with gloves and foot wear
  • Check feet for signs of injury regularly
  • Inspect for skin conditions such as frostbite or burn blisters in extreme weather conditions
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