cellulitis

cellulitis, bacterial infection of the skin. Cellulitis can be caused by any bacteria that enters a superficial skin wound, but often they are strains of Staphylococcus or Streptococcus. The condition commonly affects the lower extremities but can occur anyplace on the body where the skin has broken. If left untreated, infection can spread to the bloodstream and lymph nodes, leading to a potentially life-threatening situation. The possibility for cellulitis to become a severe condition escalated following the emergence of methicillin-resistant Staphylococcus aureus (MRSA) bacteria. Cellulitis is not usually contagious, although skin-to-skin open-wound contact could spread infection.

Risk factors

Several risk factors have been identified that increase the likelihood of developing cellulitis. Persons with weakened immune systems, including as a result of immunosuppression from corticosteroids or other medications, are at increased risk. Excess weight, diabetes mellitus, and a history of peripheral vascular disease are also risk factors. Skin conditions that increase risk include athlete’s foot, eczema, psoriasis, impetigo, herpes zoster (shingles), and chickenpox. Breaks in the skin from other causes also increase risk, including scrapes, burns, ulcers, surgical incisions, tattoos, piercings, injections, and insect, spider, or other animal bites. People with chronic swelling of limbs or a previous cellulitis diagnosis are also at increased risk. Cellulitis recurs in about one-third of patients.

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Symptoms

The primary symptom of cellulitis is a change in skin appearance. This can include erythema (redness), edema (swelling), blistering, spotting, bruising, discoloration, or a bumpy texture. Skin may also look tight or glossy. These symptoms may be accompanied by pain, tenderness, and warmth. Usually only the skin on one side of the body is affected. The infection may also cause fever and be accompanied by chills, headache, nausea, vomiting, fatigue, or weakness. Because cellulitis causes swelling, it may be difficult to walk or to move affected body parts. Muscle aches and joint stiffness may also occur, and the lymph nodes near the affected region may be swollen.

Diagnosis, treatment, and prevention

The diagnosis of cellulitis is based largely on physical examination but may also involve evaluation of a blood culture and a complete blood count to check for infection. A skin test and bacterial culture may also be performed to identify bacterial type, which can inform treatment decisions. Immediate medical attention is required for spreading skin redness, especially in the presence of swelling, tenderness, and fever. Treatment consists primarily of antibiotic therapy, which typically includes an oral antibiotic and sometimes a topical antibiotic for the wound. In more serious cases, an antibiotic may be given intravenously. Pain medications, such as nonsteroidal anti-inflammatory drugs, may help relieve symptoms. With treatment, cellulitis typically resolves after 7 to 10 days. If left untreated, severe cases of cellulitis may result in amputation.

Cellulitis can be prevented through hygiene, including immediate and proper cleaning and care of wounds. An antibiotic ointment or cream may be used to protect wounds. Patients who have previously experienced cellulitis and are at high risk of wounds may be prescribed low-dose long-term preventive antibiotics.

Complications

Complications of cellulitis are uncommon but can be life-threatening. Untreated cellulitis can lead to endocarditis (inflammation of the heart), osteomyelitis (bone infection), suppurative or septic arthritis (joint infection), thrombophlebitis (swelling of the veins), lymphangitis (inflammation of lymph vessels), meningitis (inflammation of the membranes covering the brain and spinal cord), gangrene, toxic shock syndrome, or sepsis. In severe cases, the infection can spread to the fascia, causing necrotizing fasciitis, which requires urgent medical attention.