Cellulitis

Answer 1

Definition

Cellulitis is a common skin infection caused by bacteria.

See also:

• Orbital cellulitis
• Periorbital cellulitis

Alternative Names

Skin infection - bacterial

Causes, incidence, and risk factors

Staphylococcus and streptococcus bacteria are the most common causes of cellulitis.

The skin normally has many types of bacteria living on it. When there is a break in the skin, however, bacteria can enter the body and cause infection and inflammation. The skin tissues in the infected area become red, hot, irritated, and painful.

Risk factors for cellulitis include:

• Cracks or peeling skin between the toes
• History of peripheral vascular disease
• Injury or trauma with a break in the skin (skin wounds)
• Insect bites and stings, animal bites, or human bites
• Ulcers from diabetes or a blockage in the blood supply (ischemia)
• Use of corticosteroid medications or medications that suppress the immune system
• Wound from a recent surgery

Symptoms

• Fever
• Signs of infection:
  • Chills, shaking
  • Fatigue
  • General ill feeling (malaise)
  • Muscle aches, pains (myalgias)
  • Warm skin, sweating
• Pain or tenderness in the area with the rash or sore
• Skin redness or inflammation that increases in size as the infection spreads
• Skin sore or rash (macule):
  • Comes on suddenly
  • Grows quickly in the first 24 hours
  • Usually has sharp borders
• Tight, glossy, "stretched" appearance of the skin
• Warmth over the area of redness

Other symptoms that can occur with this disease:

• Hair loss at the site of infection
• Joint stiffnesscaused by swelling of the tissue over the joint
• Nausea and vomiting

Signs and tests

During a physical examination, the doctor may find:

• Redness, warmth, and swelling of the skin
• Swelling and drainage if the infection is around a skin wound
• Swollen glands(lymph nodes) near the cellulitis

Your health care provider may mark the edges of the redness with a pen, to see if the redness goes past the marked border over the next several days.

Tests that may be used:

• Blood culture
• Complete blood count (CBC)

Treatment

Cellulitis treatment may require a hospital stay if:

• You are very sick (very high temperature, blood pressure problems, nausea and vomiting that does not go away)
• You have been on antibiotics and the infection is getting worse
• Your immune system is not working well (due to cancer, HIV)
• You have an infection around your eyes

Most of the time, treatment with oral antibiotics and close follow-up is enough. Treatment is focused on controlling the infection and preventing complications.

You may receive antibiotics to control the infection, and analgesics to control pain.

Raise the infected area higher than your heart to reduce swelling. Rest until your symptoms improve.

Expectations (prognosis)

It is possible to be cured with 7 - 10 days of treatment. Cellulitis may be more severe in people with chronic diseases and those who are more prone to infection because their immune system is not working properly (immunosuppressed).

People with fungal infections of the feet may have cellulitis that keeps coming back. The cracks in the skin offer an opening for bacteria to get inside.

Complications

• Bone infection (osteomyelitis)
• Inflammation of the lymph vessels (lymphangitis)
• Meningitis (if cellulitis is on the face)
• Sepsis, shock
• Tissue death (gangrene)

Calling your health care provider

Call your health care provider if:

• You have symptoms of cellulitis
• You are being treated for cellulitis and you develop new symptoms, such as persistent fever, drowsiness, lethargy, blistering over the cellulitis, or red streaks that spread

Seek medical attention immediately if the cellulitis is on your face.

Prevention

Protect your skin by:

• Keeping your skin moist with lotions or ointments to prevent cracking
• Wearing shoes that fit well and provide enough room for your feet
• Learning how to trim your nails to avoid harming the skin around them
• Wearing appropriate protective equipment when participating in work or sports

Whenever you have a break in the skin:

• Clean the break carefully with soap and water
• Cover with a bandage and change it every day until a scab forms
• Watch for redness, pain, drainage, or other signs of infection

References

Stevens DL, Bisno AL, Chambers BF, Everett ED, Dellinger P, Goldstein EJ, et al. Infectious Diseases Society of America. Practice guidelines for the diagnosis and management of skin and soft-tissue infections. Clin Infect Dis. 2005;41:1373-1406.

Abrahamian FM, Talan DA, Moran GJ. Management of skin and soft-tissue infections in the emergency department. Infect Dis Clin North Am. 2008;22:89-116.

Answer 2

Definition

Cellulitis is a common skin infection caused by bacteria.

See also:

• Orbital cellulitis
• Periorbital cellulitis

Alternative Names

Skin infection - bacterial

Causes, incidence, and risk factors

Staphylococcus and streptococcus bacteria are the most common causes of cellulitis.

Normal skin has many types of bacteria living on it. When there is a break in the skin, these bacteria can cause a skin infection. Skin in the infected area will become red, hot, irritated, and painful.

Risk factors for cellulitis include:

• Cracks or peeling skin between the toes
• History of peripheral vascular disease
• Injury or trauma with a break in the skin (skin wounds)
• Insect bites and stings, animal bites, or human bites
• Ulcers from certain diseases, including Diabetes and vascular disease
• Use of corticosteroid medications or medications that suppress the immune system
• Wound from a recent surgery

Symptoms

Symptoms of cellulitis include:

• Fever
• Pain or tenderness in the affected area
• Skin redness or inflammation that gets bigger as the infection spreads
• Skin sore or rash that starts suddenly, and grows quickly in the first 24 hours
• Tight, glossy, "stretched" appearance of the skin
• Warm skin in the the area of redness

Signs of infection:

• Chills or shaking
• Fatigue
• General ill feeling
• Muscle achesand pains
• Warm skin
• Sweating

Other symptoms that can occur with this disease:

• Hair loss at the site of infection
• Joint stiffnesscaused by swelling of the tissue over the joint
• Nausea and vomiting

Signs and tests

The health care provider will perform a physical exam. This may reveal:

• Redness, warmth, and swelling of the skin
• Possible drainage, if there is an infection
• Swollen glands(lymph nodes) near the affected area

Your health care provider may mark the edges of the redness with a pen, to see if the redness goes past the marked border over the next several days.

Tests that may be done:

• Blood culture
• Complete blood count (CBC)
• Culture of any fluid or material inside the affected area

Treatment

Most of the time, treatment involves antibiotics taken by mouth and close follow-up by your doctor. You may be given painkillers.

You should raise the infected area higher than your heart to reduce swelling. Rest until your symptoms improve.

You may need to stay in a hospital if:

• You are very sick (for example, you have a very high temperature, blood pressure problems, or nausea and vomiting that does not go away)
• You have been on antibiotics and the infection is getting worse
• Your immune system is not working well (due to cancer, HIV)
• You have an infection around your eyes
• You require antibiotics through a vein (IV)

Expectations (prognosis)

Cellulitis usually goes away with 7 - 10 days of antibiotics. Longer treatment may be needed if cellulitis is more severe. This may occur if you have a chronic diseases or your immune system is not working properly.

People with fungal infections of the feet may have cellulitis that keeps coming back. The cracks in the skin from the fungal infection allows the bacteria entry to the skin.

Complications

• Blood infection (sepsis)
• Bone infection (osteomyelitis)
• Inflammation of the lymph vessels (lymphangitis)
• Inflammation of the heart (endocarditis)
• Meningitis
• Shock
• Tissue death (gangrene)

Calling your health care provider

Call your health care provider if:

• You have symptoms of cellulitis
• You are being treated for cellulitis and you develop new symptoms, such as persistent fever, drowsiness, lethargy, blistering over the cellulitis, or red streaks that spread

Seek medical attention immediately if the cellulitis is on your face.

Prevention

Protect your skin by:

• Keeping your skin moist with lotions or ointments to prevent cracking
• Wearing shoes that fit well and provide enough room for your feet
• Learning how to trim your nails to avoid harming the skin around them
• Wearing appropriate protective equipment when participating in work or sports

Whenever you have a break in the skin:

• Clean the break carefully with soap and water. Apply an antibiotic cream or ointment every day.
• Cover with a bandage and change it every day until a scab forms.
• Watch for redness, pain, drainage, or other signs of infection.

References

Habif TP, ed. Clinical Dermatology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2009; chap 9.

Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 90.

Reviewed By

Review Date: 05/13/2011

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine. Kevin Berman, MD, PhD, Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.