HEALTH TALK: Cellulitis

INTRODUCTION

Cellulitis is a potentially serious bacterial infection of your skin. It appears as a swollen, red area of skin that feels hot and tender, and it may spread quickly.

Skin on your face or lower legs is most commonly affected by this infection, though cellulitis can occur on any part of your body. It may be superficial – affecting only your skin’s surface – but cellulitis may also affect the tissues underlying your skin and can spread to your lymph nodes (glands) and bloodstream.

If untreated, the spreading bacterial infection may rapidly turn into a life-threatening condition. So it’s important to recognize the signs and symptoms of cellulitis and to seek immediate medical attention it they occur.

SIGNS AND SYMPTOMS

Cellulitis will cause skin to be:

•    Red
•    Swollen
•    Tender (painful when touched or pressure applied)
•    Warm

The change in your skin may be accompanied by a fever. With time, the area of redness tends to expand. Small red spots may appear on top of reddened skin and, less commonly, small blisters may form and burst.

CAUSES

When one or more types of bacteria enter through a crack or break in your skin, cellutitis occurs. The two most common types of bacteria that cause cellulitis are streptococcus and staphylococcus.

Cellulitits can occur anywhere on your body, but the most common location is the legs, especially near your shin and ankles. Disrupted areas of skin, such as where you’ve had recent surgery, cuts, puncture wounds, an ulcer, dermatitis or eczema, or athlete’s foot, serve as the most likely areas for bacteria to enter.

Certain types of insects or, less commonly in our environment, spider bites can also transmit the bacteria that start the infection. Areas of dry skin or flaky skin can also be an entry point for bacteria, as can swollen skin.

RISK FACTORS

Several factors put you at greater risk of developing cellulitis.

•    Age. As you get older, your blood circulation system becomes less effective at delivering blood – with its infection-fighting white blood cells – to some areas of your body. As a result, skin abrasions may lead to infections such as cellulitis where your circulation is poor.

•    Weakened immune system. Illnesses that result in weakening of your immune system leave you more open to infections such as cellulitis. Certain types of leukemia and HIV infection are examples. Taking immune suppressing drugs, such as prednisolone, also can leave you more vulnerable to infections. These drugs are used in a variety of illnesses, such as asthma and rheumatoid arthritis, and to help prevent rejection of organs in people who receive transplants.

•    Diabetes. Not only is your blood sugar level increased in diabetes but your immune system is also impaired, increasing your risk of infection. Your skin is one of the many body areas that become more likely to be infected. Diabetes also results in decreased circulation of blood to your legs and feet, potentially leading to chronic ulcers of your feet. Remember too that your nerves are damaged in diabetes, so you may not feel that you have sustained an abrasion or other injury to your extremity. These portals of entry, including ulcers, allow entry for bacterial infections.

•    Chickenpox and shingles. These common viral diseases typically cause broken blisters on the skin that can serve as potential entry points for bacterial invasion and infection.

•    Chronic fungal infection on your feet and toes. Recurrent fungal infection of your feet or toes can cause cracks in your skin, increasing your risk for cellulitis.

•    Chronic swelling of your arms or legs (lymphedema). Swollen tissues may crack, leaving your skin vulnerable to bacterial infection.

WHEN TO SEEK MEDICAL ADVICE

If you have a rash that’s red, swollen, tender and warm – and it’s expanding – try to see doc the same day. If a fever or pain is also present, or the rash is changing rapidly, seek emergency care. It’s important to identify and treat cellulitis early because the condition can cause a serious infection by spreading rapidly throughout your body.

SCREENING AND DIAGNOSIS

Your skin’s appearance will help the doctor make a diagnosis. He or she may also suggest blood tests, a wound culture or other test to help rule out a blood clot deep in the veins of you legs (DVT). Cellulitis in the lower leg is characterized by signs and symptoms that may be similar to those of a DVT, such as warmth and swelling.

COMPLICATIONS

The reddened skin or rash may signal a deeper, more serious infection of your skin’s inner layers. Once below the skin, the bacteria can spread quickly, entering the glands and bloodstream and spreading throughout your body.

In rare cases, the infection can spread to the deep layer of tissue called the fascial lining. Flesh-eating strep, also called necrotizing fasciitis (remember this from TV in the U.S. some years back?) is an example of a deep-layer infection. This is an extreme emergency.

TREATMENT

An antibiotic by mouth may be prescribed to treat cellulitis. Doctor will likely follow you up one or two days after starting you on one, but not always, particularly if he’s pretty confident it’s the one(s) that will do the trick (or is not the type to bleed you of another fee). Antibiotics are usually taken for about ten days, during which time, cellulitis signs and symptoms will often disappear (like in a few days). If they don’t clear up, if they’re extensive (signs and symptoms, that is), or if you have a high fever, you may need to be hospitalized and receive antibiotics through your veins.

Antibiotics are usually prescribed that are effective against both streptococci and staphylococci. One will be chosen based on your circumstances.

PREVENTION

To help prevent cellulitis and other infections, the following measures may help every time you have a skin wound.

•    Apply an antibiotic cream or ointment. For mort superficial wounds, this provides adequate protection.

•    Wash your wound daily with soap and water. Do this gently as part or your normal bathing.

•    Cover your wound with a bandage. This keeps the wound clean and bacteria out. If you have draining blisters, keep them covered until a scab forms.

•    Change bandages often. This means at least daily or whenever the bandage becomes wet or dirty.

•    Watch for signs of infection. Redness, pain and drainage all indicate possible infection and the need for medical assessment.

Diabetes and those with poor circulation need to take extra care to protect skin wounds and treat any cuts or cracks in the skin immediately. Good measures for skin-care include the following:

•    Moisturize your skin regularly. Lubricating your skin helps prevent cracking and peeling.

•    Trim your fingernails and toenail carefully. Take care not to injure the surrounding skin.

•    Protect your hands and feet. Wear proper footwear and gloves.

•    Promptly treat any superficial skin infections, such as athlete’s foot. Infections on your skin’s surface can easily spread from person to person. Start treatment soon

See you next week.