Cellulitis

Cellulitis is a common infection of the skin and the soft tissues underneath the skin. It occurs when bacteria invade broken or normal skin and start to spread just under the skin or in the skin itself. This results in infection and inflammation. Inflammation is a process in which the body reacts to the bacteria. Inflammation may cause swelling, redness, pain, or warmth. A specific danger zone for cellulitis is located in the middle of the face in a triangle that is drawn around the contour of the nose. This area is drained by veins that directly lead into the inside of the brain case and cause easily spread infection into the brain or cause meningitis. Any skin redness and pain or burning or infected acne that appears in this area is best treated by an Ear Nose and Throat sooner rather than later. Avoid trying to squeeze white heads in this area.

danger-zonePeople at risk for getting cellulitis include those with trauma to the skin or other medical problems such as the following:

  • Diabetes
  • Circulatory problems such as inadequate blood flow to the limbs, poor venous or lymphatic drainage, or varicose veins
  • Liver disease such as chronic hepatitis or cirrhosis
  • Skin disorders such as eczema, psoriasis, or infectious diseases that cause skin lesions such as chickenpox

Causes of cellulitis include:

  • Injuries that break the skin
  • Infections related to a surgical procedure
  • Any breaks in the skin that allow bacteria to invade the skin (examples are chronic skin conditions such as eczema or psoriasis)
  • Foreign objects in the skin
  • Infection of bone underneath the skin (An example is a long-standing open wound that is deep enough to expose the bone to bacteria. Sometimes this occurs in people with diabetes who cannot feel their feet.)

Cellulitis Symptoms
Cellulitis can occur in almost any part of the body. Most commonly it occurs in areas that have been damaged or are inflamed for other reasons, such as inflamed lesions, contaminated cuts, and areas with poor skin condition or bad circulation. The common symptoms of cellulitis are as follows:

  • Redness of the skin
  • Red streaking of the skin or broad areas of redness
  • Swelling
  • Warmth
  • Pain or tenderness
  • Drainage or leaking of yellow clear fluid or pus from the skin
  • If the condition spreads to the body via the blood, then fevers and chills can result.

Call the doctor if you experience any of the following signs or symptoms of cellulitis:

  • Fevers or chills
  • Redness on the skin
  • Red streaks from skin
  • Increased warmth
  • Swelling
  • Tenderness
  • Drainage from the skin

Go to the nearest emergency department if you have any signs or symptoms of cellulitis, especially the following:

  • High fevers or chills
  • Nausea and vomiting
  • Obvious enlargement or hardening of the reddened area
  • Increasing pain
  • Numbness of the reddened or tender area when touched
  • Other medical problems that may be affected by even a minor infection

Exams and Tests for Cellulitis
Most likely the diagnosis of cellulitis will be made based on a medical history, physical exam, and these exams and tests:

  • A blood test if the infection is severe enough to be in the bloodstream.
  • The doctor also may order an X-ray of the area if there is concern that a foreign object is in the skin or that bone underneath is infected.
  • The doctor may try to draw fluid from the affected area with a needle and send the fluid to the laboratory for a culture.

Cellulitis Treatment and Care at Home
You can take the following steps to treat and care for cellulitis at home:

  • Rest the area of the body involved.
  • Elevate the area of the body involved. This will help decrease swelling and relieve discomfort.
  • Use over-the-counter pain relievers such as acetaminophen (Tylenol) or ibuprofen (Motrin). This will decrease the pain as well as help keep the fever down.

Medical Treatment for Cellulitis

  • If the cellulitis infection is not too severe, you can be treated at home. The doctor will give you a prescription for antibiotics to take by mouth for a week to 10 days.
  • The doctor may use intravenous (IV) or intramuscular antibiotics in certain situations:
  • If the infection is severe
  • If you have other medical problems
  • If you are very young or very old
  • If the cellulitis involves extensive areas or areas close to important structures like infection around the eye socket
  • If the infection worsens after taking antibiotics for 2-3 days
  • You may need hospitalization if the infection is well developed, extensive, or in an important area, like the face. In most of these cases, IV antibiotics need to be given until the infection is under good control (2-3 days) and then you can be switched to oral medications to be taken at home.

Medications for Cellulitis

Antibiotic medications for cellulitis are prescribed by mouth or by injection. Be sure to tell your doctor about any reactions you may have had in the past to antibiotics.

Surgery for Cellulitis

  • Rarely, severe cellulitis infection may need surgery.
  • An abscess, or collection of pus in the tissue, may need to be opened surgically to allow drainage.
  • Dead tissue may need to be cut away to allow healing.

Next Steps for Cellulitis Treatment

Follow-up
Once you leave the doctor’s office, be sure to take all the antibiotics prescribed for your cellulitis. The doctor may want to see you in 2-3 days to see if the cellulitis is improving.

Cellulitis Prevention

  • To prevent cellulitis, it is very important to keep your skin clean by practicing good personal hygiene.
  • If you notice pain or discomfort from an area of the skin, check to see what it looks like. If it appears inflamed and progresses from one day to the next, you will most likely need treatment.
  • Avoid situations that may injure your skin, especially if you have swelling from circulatory problems.
  • Wear sturdy, well-fitting shoes or slippers with loose-fitting cotton socks. Avoid walking barefoot in areas where you do not have a good idea about what you are walking on, for example, in garages, on a littered beach, or in the woods.
  • If you do injure your skin, wash the area with soap and water and check to make sure that the injury is getting better over the next several days.
  • Certain injuries may be at greater risk for cellulitis infection than others. You may need to take antibiotics to prevent infection or have other preventive care. Be sure to contact your doctor if you have injuries such as these:
  • Animal or human bites
  • Puncture injuries deeper than a half-inch, such as stepping on a nail
  • Crushed tissue that bleeds, burns that blister, frostbite, or deep injuries with dirt in them
  • Injuries in contact with sea water, especially if you have liver disease
  • Find out if you have diabetes or other significant medical conditions, such as liver or kidney disease. These conditions may be present without symptoms. Follow your doctor’s instructions for improving these conditions.
  • Talk to your doctor if you have swelling in your limbs that does not go away.