Cellulitis is a potentially serious bacterial infection of your skin. Cellulitis appears as a swollen, red area of skin that feels hot and tender, and it may spread rapidly. Cellulitis can be caused by normal skin flora or by exogenous bacteria, and often occurs where the skin has previously been broken: cracks in the skin, cuts, burns, insect bites, surgical wounds, or sites of intravenous catheter insertion. The mainstay of therapy remains treatment with appropriate antibiotics. Skin on the face or lower legs is most commonly affected by this infection, though cellulitis can occur on any part of the body. Cellulitis may be superficial — affecting only the surface of the skin — but cellulitis may also affect the tissues underlying the skin and can spread to the lymph nodes and bloodstream.
Cellulitis is characterized by redness, swelling, warmth, and pain or tenderness. Cellulitis frequently occurs on exposed areas of the body such as the arms, legs, and face. Other symptoms can include fever or chills and headaches. In advanced cases of cellulitis, red streaks (sometimes described as ‘fingers’) may be seen traveling up the affected area. The swelling can spread rapidly.
It occurs when one or more types of bacteria enter through a crack or break in your skin. The two most common types of bacteria that cause cellulitis are streptococcus and staphylococcus.
Although cellulitis can occur anywhere on your body, the most common location is the legs, especially near your shins and ankles. Disrupted areas of skin, such as where you’ve had recent surgery, cuts, puncture wounds, an ulcer, athlete’s foot or dermatitis, serve as the most likely areas for bacteria to enter.
Certain types of insect or spider bites also can transmit the bacteria that start the infection. Areas of dry, flaky skin also can be an entry point for bacteria, as can swollen skin.

Risk factors

The elderly and those with weakened immune systems are especially vulnerable to contracting cellulitis. Diabetics are more prone to cellulitis than the general population because of impairment of the immune systems; they are especially prone to cellulitis in the feet because their disease causes impairment of blood circulation in their legs leading to their having foot ulcers that commonly become infected. Cellulitis is also a common complication of obesity.
Immunosuppressive drugs, HIV, and other illnesses or infections that weaken the immune system are also factors that make infection more likely. In addition, chickenpox and shingles often result in blisters which break, providing a gap in the skin through which bacteria can enter. Lymphedema, which causes swelling on the arms and/or legs, can also put an individual at risk.
Diseases that affect blood circulation in the legs and feet, such as chronic venous insufficiency and varicose veins, are also risk factors for cellulitis.
Cellulitis is also extremely prevalent amongst dense populations sharing hygiene facilities and common living quarters. Military installations which require communal showers provide such an environment, as it is prevalent among many recruits going through boot camp.

Prevention

Good hygiene and good wound care lower the risk of cellulitis. Any wounds should be cleaned and dressed appropriately. Changing bandages daily or when they become wet or dirty will reduce the risk of contracting cellulitis. Medical advice should be sought for any wounds which are deep, dirty or if there is concern about retained foreign bodies.
To help prevent cellulitis and other infections, follow these measures any time you have a skin wound:

  • Wash your wound daily with soap and water. Do this gently as part of your normal bathing.
  • Apply an antibiotic cream or ointment. For most surface wounds, a single- or double-antibiotic ointment provides adequate protection.
  • Cover your wound with a bandage. This helps keep the wound clean and bacteria out. If you have draining blisters, keep them covered until a scab forms.
  • Change bandages often. Change them at least daily or whenever the bandage becomes wet or dirty.
  • Watch for signs of infection. Redness, pain and drainage all signal possible infection and the need for medical evaluation.

People with diabetes and those with poor circulation need to take extra precautions to prevent skin wounds and treat any cuts or cracks in the skin promptly. Good skin-care measures include the following:

  • Moisturize your skin regularly. Lubricating your skin helps prevent cracking and peeling.
  • Trim your fingernails and toenails carefully. Take care not to injure the surrounding skin.
  • Protect your hands and feet. Wear appropriate footwear and gloves.
  • Promptly treat any superficial skin infections, such as athlete’s foot. Infections on the surface of the skin (superficial) can easily spread from person to person. Don’t wait to start treatment.

Treatment

Antibiotics – typically a combination of intravenous and oral antibiotics are administered. Bed rest and elevation of affected limbs is also recommended.
Some times Cellulitis treatment may require hospitalization if it is severe enough to warrant intravenous antibiotics and close observation. At other times, treatment with oral antibiotics and close outpatient follow-up is enough. Treatment is focused on control of the infection and prevention of complications.

Cellulitis in women

Acute cellulitis is seen in all age groups. Nevertheless, some cellulitis syndromes have a predilection for specific populations based upon demographic factors such as age and sex. These syndromes do not seem to be caused by unique organisms but appear to result from disruption of normal skin drainage patterns. For example, recurrent cellulitis complicating saphenous venectomy for coronary artery bypass grafting occurs predominantly in men over the age of 50 years who are most likely to undergo this surgical procedure.
There are two syndromes of cellulitis that are predominantly seen in women. They represent late complications of surgeries that involve lymph node dissection and/or breast cancer surgery. One syndrome is cellulitis complicating arm lymphedema (resulting from ipsilateral axillary lymph node dissection) or breast surgery after treatment of breast cancer. The other syndrome is cellulitis following pelvic or inguinal lymphadenectomy for gynecologic cancer and includes skin changes in the lower abdominal wall, inguinal, and upper thigh regions. Both presentations are generally associated with systemic toxicity.

Sources: Patients up to Date, Mayo Clinic

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