10 Diabetic Skin Problems
Here It Is, Cellulitis In A Nutshell
Cellulitis is an infection that is the "bread and butter" of Infectious Diseases Physicians and other doctors worldwide. While it doesn't evoke the spine-tingling tension of an Ebola outbreak or SARS, cellulitis is an important condition that affects countless numbers of people every year.
What is cellulitis?
First of all, cellulitis has got nothing to do with cellulite. So if you are seeking information on "thunder thighs" and their reduction, read no further! Cellulitis is infection of the tissue under the skin - the "subcutaneous" tissue. The infection tends to spread through special blood vessels in the body known as lymphatics.
Is it rare?
Not at all. Cellulitis would be one of the most common reasons for hospital admission amongst Infectious Diseases units.
Where do you get cellulitis?
By definition, cellulitis can affect any part of the body covered by skin. But, in practice, the most common part of the body affected by cellulitis is the leg; therefore, the emphasis of this article will be cellulitis in that part of the body.
Which bugs cause cellulitis?
Cellulitis is usually caused by bacteria that live on our skin. For the vast majority of our lives, these skin bacteria have been peacefully co-existing on us. But on some occasions, they can stir up trouble and cause cellulitis. Out of all our skin bacteria, the two most frequent culprits are Group A Streptococcus (also known as Streptococcus pyogenes) and Staphylococcus aureus (also known as "golden staph"). There are other causes which will be discussed below (see "Severe forms of cellulitis").
How do you get cellulitis?
Sometimes, patient with cellulitis will recall a break in the skin that has become infected e.G. A cut, a scratch or a surgical wound. But more often than not, there is no history of trauma to the affected part of the body; however, there are a number of risk factors that predispose people to cellulitis.
What are the risk factors for cellulitis?
Tinea pedis
This is a common fungal infection also known as "Athlete's Foot". It causes a break in the skin between the toes but usually causes no symptoms. The fungus itself doesn't cause cellulitis; but, the breach in the skin provides a portal of entry for skin bacteria to wreak their microbial mayhem, causing cellulitis.
Peripheral vascular disease (blocked arteries in the leg)
A healthy blood supply to the extremities is vital to prevent infection. People with blocked arteries in the leg are at higher risk of cellulitis. The two most common groups in which blocked arteries in the leg are seen are chronic smokers and diabetics.
Chronic venous insufficiency
Damaged veins in the leg can increase the risk of cellulitis of the leg. This is often a consequence of aging and other conditions, such as varicose veins. People with chronic venous hypertension usually have thickened skin, dermatitis and small star-like veins over the leg.
Lymphoedema
Lymphatics are vessels that carry a clear liquid to the lymph nodes. The lymphatic system is a vital part of our immune system so any disruption to it increases the risk of infection. When disruption to the lymphatic vessels occurs, it results in swelling of the affected limb called lymphoedema. This can occur spontaneously, be a complication of surgery (e.G. Lymphoedema of the arm following breast cancer surgery) or infection (e.G. Filariasis).
Generalized reduction in the body's immunity Any condition that reduces the body's ability to fight infection increases the risk of cellulitis e.G. In diabetes and in people who take immune-lowering medications.
What happens when you get cellulitis of the leg?
Typically, your foot or leg will start hurting and then become red, hot and swollen - but the order of these symptoms is variable. With time, the affected area of the leg will extend upwards. The infection spreads via the lymphatic vessels which run up the inside thigh and into the lymph nodes at the very top of the thigh; therefore, patients may have a streak of redness and pain on the inside and top of the thigh. Some patients can become generally unwell with fevers, uncontrollable shivering and sweating.
Serious complications of cellulitis Septicaemia Amputation Death
How do you diagnose it?
Cellulitis is purely a clinical diagnosis. Blood and radiological tests are only useful to clarify the severity and extent of the condition.
What is the usual treatment of cellulitis?
Antibiotics (usually penicillin-based) in oral or intravenous form.
Elevation of the affected leg and bed rest Treat the underlying cause e.G. Give antifungal cream for tinea pedis, encourage better control of diabetes and refer to a Vascular Surgeon if there is a history of blocked arteries.
Severe forms of cellulitis Although cellulitis is generally not life-threatening, there are a few exceptions:
Necrotizing skin and soft tissue infections
These are fulminant conditions associated with a very high death rate that include "necrotizing fasciitis", "synergistic gangrene" and "gas gangrene". You may sometimes read in the media of cases described as being caused by "flesh eating bacteria". These are technically not just cellulitis because they end up spreading much deeper than the subcutaneous tissue. People with these conditions have severe pain in the affected areas, often associated with large blisters. They also look very unwell from the end of the bed. The only cure is surgery in conjunction with antibiotics, sometimes involving many operations. Often the operated area will be completely exposed e.G. An open abdomen with the intestines visible or an open leg with the bones on full display.
Dog and cat bites
In Sri Lanka, animal bites, especially from stray dogs, rightly make us worry about rabies. But they also harbour a bacterium called Pasteurella in their mouths. If introduced into our skin through a bite or scratch, they can cause an aggressive form of cellulitis that loves to invade the tendons and joints. These patients often need surgery in addition to antibiotics.
Cellulitis from water
When cellulitis occurs following an injury in water, different bacteria have to be considered. Aeromonas and Vibrio are two bacteria that we worry about, in particular. They can both cause severe blistering infections. Also it is vital to ask the patient about exposure to water as these bacteria require different antibiotics compared to standard cellulitis. For those readers who like the outdoors, it is worth remembering that leech bites complicated by cellulitis are often due to Aeromonas and require special antibiotics.
So there you have it - cellulitis in a nutshell. The take home message is that it is a common condition which has the potential to become very serious if not attended to promptly.
(The writer is an Infectious Diseases Physician and Associate Professor of Medicine at the Australian National University)
Ask The Doctors: Cellulitis And Cellulite Are Not The Same Thing
ERROR: The request could not be satisfiedRequest blocked. We can't connect to the server for this app or website at this time. There might be too much traffic or a configuration error. Try again later, or contact the app or website owner. If you provide content to customers through CloudFront, you can find steps to troubleshoot and help prevent this error by reviewing the CloudFront documentation.
Generated by cloudfront (CloudFront) Request ID: Jmo_mz2SUO8xo0DVQgg9nUFMUf9KiZTj4mwkmGTpBiwbttBhu2lnig==Understanding Cellulitis In Children
Cellulitis is a common and highly treatable bacterial skin infection. It begins as a painful, discolored, swelling skin patch. It's important to get medical attention quickly if you suspect cellulitis. Untreated, the bacteria can spread and cause complications.
Many cellulitis infections occur from common skin bacteria. Usually, people can manage them at home with oral antibiotics. Sometimes, emergency room (ER) or hospital care is necessary. Cellulitis is common in adults and children. Often, symptoms begin abruptly without an obvious cause.
If you suspect your child has cellulitis, contact a doctor's office right away. Early diagnosis and treatment can help prevent the infection from spreading to the bloodstream and other body parts.
Learn more about cellulitis.
Cellulitis is a common bacterial skin infection. It usually involves a painful skin area with discoloration, warmth, and swelling that enlarges rapidly.
In adults, cellulitis is most common on the lower legs. But in children, cellulitis can appear on the head, neck, limbs, or trunk. Sometimes, it can cause complications like skin abscesses.
Rarely the bacteria can spread to the surrounding tissues or bloodstream. But once a doctor identifies cellulitis and starts providing treatment, many children can recover quickly.
Cellulitis begins as a slightly swollen, discolored, and warm skin area that's tender to the touch. It can be anywhere on the body.
The discoloration often expands rapidly. Sometimes, you can see discolored streaks extending from the infection site. You can draw a line around the discolored area's edge with a ballpoint pen to help monitor the spread.
As cellulitis progresses, you might notice symptoms like:
Cellulitis isn't usually itchy.
Cellulitis is an infection that occurs from common bacteria, such as Streptococcus or Staphylococcus species. We all have these bacteria living on our skin periodically.
But in cellulitis, the bacteria penetrate through tiny breaks in our protective skin barrier. Sometimes, you can see the breaks, such as cuts, scrapes, or bites. Other times, the break in the skin barrier is too small to see. Once inside, the bacteria cause a cellulitis infection in the deeper skin layers.
Your child's doctor can usually diagnose cellulitis by talking with you and examining your child's skin.
Children with serious cellulitis or other underlying medical conditions may need additional testing. This could include wound or blood cultures or imaging tests.
Let your child's doctor know if you think there have been unusual circumstances, such as exposure to water sources (hot tubs, salt water, or freshwater), bites or puncture wounds, or people at home with similar rashes.
Since cellulitis is a bacterial infection, your child's doctor can prescribe antibiotics to treat it.
People usually take oral antibiotics by mouth for at least 5 days – or as prescribed by a doctor. Occasionally, two antibiotics may be necessary to treat cellulitis.
Your doctor can choose the best medication regimen based on your circumstances and your area's bacterial resistance patterns. They may recommend intravenous (IV) antibiotics in more severe cellulitis cases.
If the cellulitis forms an abscess (pus collection), your doctor may cut and drain the area.
Breaks in the skin barrier can increase your cellulitis risk. This happens in common skin conditions like:
People with illnesses like the following, which can affect their immune systems or wound healing, may also have a higher chance of getting cellulitis:
Medications like corticosteroids, immunosuppressants, or chemotherapy can also affect the immune system and increase your skin infection risk.
To help prevent cellulitis in children, try the following:
With prompt recognition and treatment, the outlook for children with cellulitis is usually excellent.
Once your child starts antibiotics, you can expect your child to improve significantly within about 48 hours. Be sure that your child finishes the full course of antibiotics, even after they look much better.
Many children with cellulitis can safely get treatment at home and can fully recover by the time they complete their course of medication.
For severe or high risk cellulitis cases requiring hospitalization, the average hospital stay lasts about 3 days, and many children can go on to recover fully.
How serious is cellulitis in children?Cellulitis is a potentially serious bacterial skin infection. Untreated, it can spread to the bloodstream or nearby tissues and cause complications.
But with a prompt diagnosis and starting antibiotics, many children with cellulitis can fully recover at home.
What are the 3 indicators of cellulitis?In cellulitis, you might notice a skin patch with rapidly spreading:
You might also notice swollen glands or lymph nodes near the affected area. Some children may also have a fever or be unusually tired or irritable.
When should you take a child to the emergency room for cellulitis?Many cellulitis cases don't require ER or hospital care. But if your child has a serious underlying medical condition (such as cancer, diabetes, immunodeficiency, or recent surgery), immediately talk with your doctor or go to the ER.
Similarly, if your child appears very ill (high fever, fast heart rate, confusion), or their cellulitis seems severe (affecting the face/eyes, rapidly worsening, blistering, extremely painful), get immediate care.
Finally, if your child has difficulty tolerating their medication or doesn't improve after 48 hours of treatment, your doctor may direct you to the ER.
Should kids go to school with cellulitis?In general, cellulitis isn't particularly contagious. Your child can usually return to school once they're fever-free, responding well to antibiotics, and their open wounds heal.
If your child doesn't clearly improve, has a fever, or has open skin or wound discharge areas, keep them home until you talk more with your doctor.
Your doctor can help you decide when your child can return to school.
Cellulitis is a common bacterial skin infection that's highly treatable.
Talk with your child's doctor as soon as you notice cellulitis signs, such as an area of discolored, warm, painful, and swollen skin. Draw a line around the discolored area with a ballpoint pen so you and your doctor can monitor progression.
Without treatment, cellulitis can spread and cause serious complications. But many children with cellulitis can take oral antibiotics at home and improve significantly within 48 hours after starting treatment.
Contact your doctor right away if your child's symptoms worsen rapidly, your child seems seriously ill, or your child doesn't improve within 48 hours of starting prescribed antibiotic treatment.
Comments
Post a Comment