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Cellulitis is a widespread skin infection, and its treatment varies – Cellulitis.

Cellulitis is an infection that displays typical symptoms. The likelihood that this disease progresses depends on many factors.

What is cellulitis?

Cellulitis is a skin infection that involves both cutaneous and subcutaneous skin layers. This definition means that it is a profound infection of the soft tissue that could spread rapidly without treatment. On the contrary to the erysipelas infection for which it is often confused, that is a superficial infection.

What causes the infection?

This soft tissue infection could happen due to multiples microorganisms such as bacteria, viruses, and fungi. However, the source of this skin infection nearly always are bacteria. The two with more relevance, for instance, are Streptococcus pyogenes and Staphylococcus aureus. These two play their role in many other skin infections as well.

There are particular situations that, when present, the thoughts should be on other bacteria instead of the classically involved. Bite wounds by multiples animals as dogs, cats, rats, or even humans, represent an independent entity of cellulitis. The dog bite by far is the most common. Very often, multiple bacteria are involved in this infection. These bacteria are oddly found in any other infection, but, in this case, they are widespread; one of them, for example, is the Pasteurella multocida.

Moreover, when the infection occurs in an aquatic setting (as the beach, for example), due to lacerations or puncture wounds. The bacteria here involved may not be the same ones as if it was in the land. This bacterium variation is not a surprise because very different bacteria live in aquatics environments in comparison to the ground. Several bacteria are possible, but special attention must be given to Mycobacterium marinum for its resistance to standard treatment, and V vulnificus in patients with chronic liver disease.

What triggers cellulitis?

Typically, the cellulitis infection needs a door of entrance, which means that there is always at least a minimal injure in the skin for the bacteria to cross into the body. However, not on all occasions, this breach could be seen. So, the entry sometimes it is just an assumption.

Furthermore, your doctor would ask you thoroughly what type of events precede this infection. This interrogation is in light of at least know the possible event that is prompting the cellulitis. Any skin injury such as an insect bite, or puncture wound could explain a bacterial infection. Similarly, other diseases as tinea pedis, which is a fungal infection of the foot, can forecast cellulitis.

A viral infection con also prompt cellulitis. The infection by Herpes simplex may cause skin injury, and this situation could lead to cellulitis. However, this situation is unusual.

What are the symptoms of cellulitis?

Most people don’t remember any recent episode of trauma, which is the key to developing cellulitis. When the symptoms appear is usually several days after the skin’s breach, so for people, it is difficult to recall such situations, because often seem insignificant for them.

The site of infection is usually the leg, but it could happen anywhere in the body. Characteristically, nonpurulent cellulitis has an acute onset of redness in the skin is the first symptom. This redness would appear precisely where, subsequently, the cellulitis emerges. Then, other symptoms would start appearing over time in the same area, such as pain, a rise of temperature (it feels scorching), swelling, and there is a possibility for the skin to blister. A blister is a pouch filled with liquid between the layers of the skin.

The lymph nodes are structures of the body where the immune system fight external germs. The inflammation of them when the body is in the process of eliminating an infection needs to occur. Therefore, it is normal to find swollen lymph nodes nearby to the site of the infection.

The term purulent cellulitis is used when there is pus within the infection, and the most probable cause for this is Staphylococcus aureus. The pus could spontaneously drain through the wound or just stay under the skin until it completely resolves.

Moreover, the symptoms could affect the body as a whole. These symptoms could be fever, chills, malaise, fatigue, among others. When these symptoms appear, it means that the infection settled throughout the body, and it is more dangerous.

Can this infection affect my eyes?

Cellulitis can impact virtually anywhere in the skin. And, the eyes are a site where this infection usually affects, and cause symptoms. The eyes could have two types of cellulitis, orbital cellulitis, and periorbital cellulitis; the former is way more dangerous. The symptoms for the orbital disease include high fever, bulging of the eye, and the eye’s movement isn’t possible without pain. The vision could be ok, but it will start deteriorating with time. The periorbital symptoms are mostly redness and tenderness of the tissue surrounding the eye; any visual loss or impairment in the eye’s movements should be lookout closely. The periorbital infection can progress to an orbital, which is more profound, severe, and carry complications (even death).

What are the stages of cellulitis?

The severity of symptoms ranges from mild to difficult and life-threatening situations, depending upon many factors. The classification is into four stages, depending on the severity of symptoms and other diseases within the patient. Upon the progressing of the cellulitis stage, the probabilities of complications and death rise considerably.

Firstly, stage 1 patients don’t display any of the whole-body symptoms such as fever or malaise. The symptoms are only on the site of the infection, and the patient doesn’t have any other disease such as hypertension or diabetes.

Secondly, stage 2 patients could display the whole-body symptoms, or only have them within the site of infection. Nevertheless, if there are only skin symptoms, then a need for another condition to exist for being stage 2 is mandatory. Highlighting these conditions is essential because they are arterial or venous diseases. These kinds of diseases compromise the normal blood flow in the tissues; therefore, they impair infection’s resolution, and this is in association with worse outcomes.

Thirdly, for stage 3 patients, the situation is hard to solve. The symptoms for this group could worry about either patients or doctors extremely. The main symptoms include confusion, an increase in the heart and breathing rate, and hypotension. Also, in this stage, it is possible to be if the patient has a severe disease that directly interferes with the effectiveness of antibiotic therapy.

Lastly, stage 4 is the most demanding one, either for patients to cope and doctors to treat. It comprises patients with sepsis, which is a life-threatening situation by microorganisms with deadly hypotension. Also, in this stage, cellulitis can convert into necrotizing fasciitis, which we will see thoroughly further.

What are the complications of cellulitis?

The site of the infection could complicate with a more severe condition. Besides all the symptoms aforementioned, if some of the symptoms I will now illustrate are present, then the patient should immediately seek medical aid. It means that the infection is progressing to a necrotizing disease that needs immediate surgical care. The alarm signs include purple coloring of the skin, skin sloughing, a rapid progression of the infection, and loss of sensitivity in the infection site.

The disease progression similarly yields whole-body complications such as sepsis, infection in other parts of the body. All of them without receiving medical care could prompt death.

Which patients are at risk of having severe cellulitis?

Several risk factors are in association with the development of cellulitis. The elderly and children below six months are at a higher risk. Most patients with chronic conditions and a weakened immune system are vulnerable to the infection. Some of them could be cancer, overall deficient immune system, chronic liver disease, peripheral artery disease, and chronic kidney disease. It may seem obvious, but previous episodes of cellulitis increase the chances for further re-occurrences.

Some conditions, through complex ways, halt how the body responds to skin infections. Obesity is one of them, being a significant risk factor. And patients with diabetes are at higher risk of both developing more quantity of cellulitis infections and a more severe stage of the disease.

Patients with pre-existing inflammatory skin diseases such as psoriasis and eczema, increase their chances of having cellulitis. Also, people with skin dryness are at a higher risk. This susceptibility is because of the minimal gaps within the skin. These gaps represent a pass-through for bacteria across the skin barrier in these conditions.

People with damage in the circulatory system, which mostly comprises the venous and lymphatic system are in danger. They are at higher risk because of leg’s edema and lymphedema that are complications of the former and the latter, respectively. Both of them increase the chances of having repetitive and severe cellulitis.

How dangerous is cellulitis infection?

Cellulitis accounts for more than 600,000 hospitalizations per year and including cutaneous abscess more than 9 million outpatient visits. It kills approximately 1% of the people that infects worldwide and 0,5% in the United States. So, indeed, it can be hazardous.

How do health care professionals make a diagnosis of cellulitis?

The mild and moderate cellulitis wouldn’t need anything else than a medical history and physical exam. Just by a look at the lesion by your doctor, with questions about how it happened, it is ok to start antibiotic treatment. But, in a high-risk population and severe cases, additional procedures are mandatory.

Blood laboratory exams are the first indication for an overall assessment of the infection; this would help to determine the spread of the disease from the skin. Then, specialized microbiological exams for identifying the bacteria. The bacterial culture with tissue samples from the skin infection and blood would determine the specific bacteria in the wound, and if it is already widespread in the body, correspondingly.

Other exams as computed tomographic (CT) imaging and magnetic resonance imaging (MRI), aid in the detection of severe infection as necrotizing fasciitis. Ultrasonography exams are useful for determining the hidden presence of pus collections in the tissues.

What is the treatment?

The oral antibiotic treatment is successful in 9 of every ten patients. However, if there is pus collection beneath the cellulitis lesion, maybe antibiotics alone wouldn’t be enough. For that case, surgical drainage of the pus accumulation with a dissecting instrument is a formal indication. This procedure will create a synergy with antibiotic therapy on behalf of the elimination of the remaining bacteria.

Initially, all stages 1 and 2 cellulitis infections are treated with a standard antibiotic. It is needed this way, because, after an initial diagnosis, the probability for those infections with minimal risk to be needing something else is unlikely. Therefore, unless the history of the patient tells otherwise, starting treatment without confirmatory exams is a common practice. The first antibiotic includes first or second oral cephalosporins, macrolides, or clindamycin, and others.

Notably, unique forms of super-bacteria have caused trouble over the years. This trouble exists because of its particular resistance to standard treatment, and typical acquirement in hospital settings. Therefore, more potent and intravenous antibiotic, plus staying in hospital settings for receiving therapy, becomes mandatory. A group of patients should receive special care on this topic. Patients with diabetes are keener to have these super bacteria in their infections, or multiple bacteria in one wound. So, a careful assessment with many antibiotics must be a consideration in this high-risk population.

Usually, with just three days under treatment, you could expect some betterment. Firstly, the pain diminishes until it disappears, and then the lesion starts to shrink for then becoming normal skin again.

What does the infection look like?

Here you can observe mild cellulitis, with an onset of redness in the right knee.

Cellulitis in the right knee.

What types of health care professionals treat cellulitis?

The general practitioner could handle the noncomplicated cellulitis. Nevertheless, specific complications of the infection would require other types of doctors.

Both of the eye complications that I mentioned earlier, either orbital and periorbital infection would require assessment by an ophthalmologist. If the infection isn’t resolving with standard treatment and persists over time, evaluation by a specialist in infectious diseases may be warranted.

If I think I have it, what can I do?

Please don’t worry. This tool is a cellulitis symptoms checker that would help you to determine how likely it is that you have a cellulitis disease; it is free, and would only take you a few minutes.

What do you think?

Written by Dr. Esteban Kosak

Doctor of Medicine - MD Recently Graduated from Medical School and inspired to aid the global population during this situation. I think that we shall no longer be waiting to see a doctor when we feel sick. Several times we feel disease searches in Google drive us to a rabbit hole and come out thinking that we may die of cancer or something very serious, given that symptoms may seem to fit a wide variety of illnesses. Since I recently graduated from medical school. I have all the medical information fresh in my mind. My thorough experience as an expert researcher allows me to very-well known the different diseases and conditions that affect human bodies. Empowered by the United Nations 17 Sustainable Development Goals (SGDs). I think that we all can provide a grain of sand to help humanity. That's why we created Symptoms.Care a place where you can come and screen your symptoms and find what different illnesses can be related to them. Armed with the right information you can instantly, discretely, secure and from the comfort of your home talk with a Doctor that can Evaluate your Symptoms and help you seek the right treatment.

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