It is a condition that more and more I’m seeing occurring. Felt that it was important to review it again, so that immediate treatment is executed upon establishment of the condition.

What is it?

Cellulitis is an infection of the deeper layers of skin, causing infected areas to look red and swollen, and to feel painful and hot. It is accompanied by pain and tenderness. People with lymphoedema are particularly susceptible to cellulitis, because the lymphatic system is damaged or overloaded, and does not function adequately to fight infection.

Causes

Include streptococcus bacteria. The infection may enter via a break in the skin, such as a scratch or insect bite; through a pre-existing wound or ulcer; or via an area of skin inflammation – e.g. athlete’s foot, eczema, or dermatitis. However, it may not be possible to identify the cause, and an attack may arise without warning.

How can I recognise it?

You often feel unwell, as if the ‘flu’ is starting. Symptoms can include fever, shivers, muscular aches and pains, headache, nausea, vomiting, etc. The swollen area usually develops a rash; or becomes red, hot, and tender to the touch. Swelling may dramatically increase, and pain may occur in the swollen area; the armpit; with lymphoedema of the arm, groin, or leg.

Where does it occur?

Some cases of cellulitis appear on areas of trauma, where the skin has broken open, such as  near ulcers or surgical wounds. Many times, however, it occurs where there has been no break in the skin at all. In such cases, it is difficult to know where the bacteria came from. Patients with diabetes, or impairment of the immune system, (for example from HIV/AIDS or drugs that depress the immune system), are particularly prone to developing the condition.

Other forms of non-infected inflammation may mimic cellulitis. People with poor leg circulation, for instance, often develop scaly redness on the shins and ankles; this is called “stasis dermatitis” and is often mistaken for cellulitis.

What should I do if I develop cellulitis?

Contact your doctor immediately as you will need antibiotic treatment. Treatment of cellulitis in lymphoedema is very important, because the sufferer may become very ill. As well, lymph drainage routes risk being damaged further; in which case, the swelling may worsen and permanent skin changes, e.g. thickening, may result. This does not help the long-term management of the condition.

Is it contagious?

Cellulitis is not contagious, since it is an infection of the skin’s deeper layers, the dermis, and subcutaneous tissue. The skin’s top layer (the epidermis), provides a cover over the infection. In this regard, cellulitis is different from impetigo, which is a superficial infection and is contagious.

Complications

Complications of cellulitis can include septicaemia, abscesses, necrotising fasciitis, and meningitis.

Septicaemia (Blood poisoning)

If the bacteria infecting your skin and tissue enter your bloodstream, it can lead to blood poisoning. Symptoms of blood poisoning include:

• – high temperature (fever), of 38C (100.4F) or above
• – rapid heartbeat
• – rapid breathing
• – feeling dizzy or faint
• – changes in mental behaviour, such as confusion or          disorientation
• – diarrhoea
• – reduced urine flow
• – cold, clammy skin
• – pale skin
• – loss of consciousness.

Abscesses

Some cases of cellulitis can result in an abscess forming near the site of the infection. An abscess is a swollen, pus-filled lump under the surface of the skin. It is caused by a build up of bacteria and dead white blood cells. In some cases, the antibiotics used to treat cellulitis may also help to remove the abscess. But if not, the pus will have to be drained from the abscess, through a small cut in your skin.

Necrotising fascitis

Necrotising fasciitis is a rare, but serious bacterial infection of the deep layer of skin. This causes the affected tissue to die (gangrene). Symptoms develop rapidly and include very severe pain, fever, diarrhoea, vomiting, and unconsciousness. Treatment includes surgery to remove the affected tissue, and antibiotics.

How is cellulitis treated?

First, it is crucial for the doctor to distinguish whether or not the skin inflammation is due to an infection. The patient’s history and physical examination, can provide clues in this regard, as can the white blood cell count. A swab for bacteria may also be of value.

When it is difficult to know if the inflammation is caused by an infection, doctors sometimes treat with antibiotics just to be sure. If the condition does not respond, it may need to be addressed by different methods. For example, if the inflammation is thought to be due to an autoimmune disorder, treatment may be with a corticosteroid. It is important to have your podiatrist monitor your legs if cellulitis is indeed detected, to try to maintain good tissue viability. If a break down occurs, they would manage to alleviate infection.

                              Your feet mirror your general health . . . cherish them!