What is Cellulitis?
Cellulitis is an acute inflammatory condition of the skin characterized by local pain, redness, and swelling.
Normally the defenses of the skin are adequate to restrict the infection by normally thriving bacteria on the skin surface. In case of a contaminated injury, or reduced immunity or animal bites that may introduce unusual bacterial flora, an acute inflammation may set in.
How common is Cellulitis?
In the elderly, cellulitis is common if there are other coexisting morbidities. It is very rare in normal physical health.
What are the causes and risk factors for Cellulitis?
- Age: Reduced immunity
- Heart disease: Leads to decreased venous return (blood from leg veins going to the heart) of lower limb. This is turn results in fluid retention in the feet, causing reduced oxygen levels
- Diabetes: Wound healing is poor
- Injury: Especially contaminated injuries
- Animal bites
What are the symptoms of Cellulitis?
- Pain: Felt locally and spreading in the entire limb
- Fever with or without chills
- Increased temperature of the affected skin
- Skin is tense and may ooze fluid
- If cellulitis is following an injury then the wound may show signs of delayed healing.
How is Cellulitis diagnosed?
The diagnosis is clinical. Swab from the wound may be taken for culture and antibiotic sensitivity testing. Blood sugar is estimated to rule out diabetes as it is both a risk factor and also impedes recovery from infection.
An X-ray may be ordered to rule out bone involvement. And a local ultrasound is useful in making sure the blood supply to the limb is adequate.
What is the treatment for Cellulitis?
Broad spectrum antibiotics are the mainstay of treatment which are initially started and later could be modified guided by the antibiotic sensitivity profile.
In case of hospital-acquired infections like MRSA the drug of choice is Vancomycin given intravenously.
Along with antibiotics, anti-inflammatory drugs, painkillers and multivitamin supplements are also given to enhance healing.
Limb elevation, local application of dressings that decrease the tissue edema are also adopted.
Physiotherapy of the affected limb is also recommended.
What are the complications with Cellulitis?
- Necrotising facsiitis
- Gangrene (wet gangrene or gas gangrene)
- Infection of bone (seen in very deep and penetrating injuries with contamination)
- Systemic infection – septicaemia
- Collection of pus under the skin
- Devitalization of overlying skin – patient may require removal of devitalized skin surgically (debridement)
What are the lifestyle changes recommended to prevent Cellulitis?
- Good nutrition
- Maintain personal hygiene
- Elevate the involved limb to facilitate drainage of fluid
- Immediate medical attention after trauma, especially in elderly in case of even trivial trauma
- Controlled diabetes
How to take care of someone with Cellulitis?
- Maintain local hygiene as the patient may be incapable of doing the same due to reduced usability of the limb
- Change dressings as instructed by the treating physician
- Change the bed linen every day
- Physiotherapy of the affected limb
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