Cellulitis

Risk factors include: Insect, animal, or human bitesDiabetes Weakened immune system, such as AIDSAlcoholismChronic use of steroidsKidney and liver failure Surgical procedures Poor circulation or peripheral vascular diseaseSwelling or fluid retentionIntravenous drug abuseBurnsExposure to fish, meat, hides, shellfish, poultry, or eggs Symptoms Symptoms may begin within hours or days and can include: Skin inflammation that begins in a small area and spreads. This includes: RednessPain or tendernessSwellingWarmthA red streak (possibly)Swollen lymph nodesFever or chillsFatigueHeadacheCellulitis near the eyes may cause pain with eye movements and should be treated urgently DiagnosisThe doctor will ask about your symptoms and medical history, and perform a physical exam. Expect to answer questions about how the wound occurred and exposure to animals or natural bodies of water. Your skin will be closely examined. Using a colored pen on your skin, the doctor can mark the border of the cellulitis to monitor its progress.Tests may include:Wound culturea sterile applicator swabbed across the area and sent to a lab to be tested for bacteria and type of antibiotics to use in treating the infection. (This test is rarely, if ever, performed anymore since the bacteria on the swab will reflect the bacteria that colonize our skin normally and, hence, the test is not useful.)

Blood teststo help determine the severity of the infectionX-rays , bone scans, or CAT scans to check for gangrene under the skin or evidence that the infection has spread to the bone TreatmentThe treatment goal is to eliminate the infection and reduce discomfort. Most cases of cellulitis resolve after a week or two of treatment. An infected wound can be cleaned and any dead tissue removed. If a collection of pus (called an abscess) is present, it can be drained. Severe cellulitis, cellulitis in a diabetic or immune suppressed person, or an infection on the face may require hospital care.Treatment includes: MedicationAntibiotics may be taken by mouth or injected into a muscle or vein, depending on the severity of the infection. Take the entire prescription as directed until all the medicine prescribed is used. Otherwise, the infection may return. Supportive CareThis may include resting in bed or elevating the infected area higher than your heart. The doctor might recommend applying warm or cool compresses to the area. Change your dressings as directed by your doctor, and protect your skin from additional injury. Do not scratch or rub the area. Prevention To reduce your risk of getting cellulitis:

Keep your skin cleanMoisturize dry skin with lotion Avoid injury to the skin Wear protective gear when participating in sportsWear long pants and long-sleeved shirts when hikingWear sandals when at the beach, rather than going barefootBe careful around animals, treat pets with respect to avoid bitesIf you or your child has not had chickenpox, talk to your doctor about getting vaccinatedDo not swim in natural waters if you have cuts or soresTry not to cut yourself during fishing or other water sports If a small cut, bite, or other injury occurs, carefully tend to the wound. Clean cuts or scrapes with soap and waterApply antibiotic ointmentCover with a bandage or dressingDo not scratch woundsCall the doctor immediately if the area becomes red or inflamedSeek prompt medical care for larger wounds or bitesIf your legs tend to swell, elevate them several times a day and wear support stockingsGet recommended vaccines for children and adults RESOURCES: American Academy of Dermatologyhttp://www.aad.org National Institute of Allergy and Infectious Diseaseshttp://www.niaid.nih.gov CANADIAN RESOURCE; Canadian Dermatology Associationhttp://www.dermatology.ca/index.html Health Canadahttp://www.hc-sc.gc.ca/index_e.html

References: American Medical Association website. Available at: http://www.ama-assn.org/ . Cecil Textbook of Medicine . 21st ed. WB Saunders Company; 2000. Clinical Dermatology . 3rd ed. Mosby-Year Book, Inc.; 1996. Conn's Current Therapy 2001 . 53rd ed. WB Saunders Company; 2001. Griffith's 5-Minute Clinical Consult . Lippincott, Williams and Wilkins; 2001. Harrison's Principles of Internal Medicine . 14th ed. The McGraw-Hill Companies; 2000. Principles and Practice of Infectious Diseases . 5th ed. Churchill Livingstone, Inc.; 2000. Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and managementof skin and soft tissue infections. Clin Infect Dis . 2005; 41: 1373-406. Last reviewed November 2007 by Ross Zeltser, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.