VOL: 99, ISSUE: 17, PAGE NO: 26
WHAT IS CELLULITIS?
- Cellulitis is a diffuse, acute infection of the skin and subcutaneous tissue.
- It is caused by some anaerobic microbes or by Streptococcus pyogenes or Clostridium perfringens.
- The spread of infection is aided by the formation of enzymes that break down connective tissues - which normally isolate areas of inflammation.
- In adults, cellulitis presents most commonly in the lower limbs.
Older people are particularly at risk of cellulitis. It is more likely to develop in the presence of:
- Damaged skin;
- Poor circulation;
- Diabetes mellitus;
- Chronic lymphoedema of the leg;
- Previous leg ulcer;
- An obvious portal of entry such as a surgical lesion, leg ulcer, minor abrasion, stasis eczema or intravenous drug injection site.
SIGNS AND SYMPTOMS
- Localised heat.
- Smooth shiny skin - crusting and scaling tends to be seen only in varicose eczema.
- Occasionally: fever; malaise; chills; headache; raised white cell count.
- If untreated, the products of inflammation may enter the blood causing septicaemia.
- In severe cases necrotising fasciitis may occur.
- Cellulitis in the leg spreads to affect the lymph nodes in the groin, which can become enlarged, tender and easily palpable on examination.
- Cellulitis on the face may cause enlargement of a lymph node in front of the ear or in the neck.
DIAGNOSIS AND TESTS
- Clinical examination.
TREATMENT AND THERAPIES
- Intravenous or oral antibiotics - usually benzylpenicillin/flucloxacillin - abscess and tissue destruction can occur if appropriate antibiotics are not administered.
- Prophylactic tinzaparin if there is a risk of deep vein thrombosis.
- Elevation of the affected area.
- Prevention of pressure to the affected area.
- Patients with recurrent cellulitis may be prescribed prophylactic antibiotics.
- Bed rest is necessary - passive exercise can reduce the associated complications.
- Limb elevation is important to reduce oedema.
- Pressure area care.
- Patient education once the condition has resolved. Advise on:
basic skin care and avoidance of predisposing factors where possible;
avoidance of skin damage by wearing appropriate protective equipment when taking part in work or sport;
cleaning any skin breaks carefully and monitoring for signs of infection;
and good general health in fighting potential infection.
RESEARCH AND DEVELOPMENT
- The British Medical Journal’s clinical evidence website looks at the effects of antibiotics and the effects of treatment of predisposing factors to prevent recurrence.