CELLULITIS

Cellulitis is a localized or diffuse inflammation ofconnective tissue with severe inflammation of dermal and subcutaneous layers of the skin. Cellulitis can be caused by normal skin flora or by exogenous bacteria, and often occurs where the skin has previously been broken: cracks in the skin, cuts, blisters, burns, insect bites,surgical wounds, intravenous drug injection or sites ofintravenous catheter insertion. Skin on the face or lower legs is most commonly affected by this infection, though cellulitis can occur on any part of the body. The mainstay of therapy remains treatment with appropriate antibiotics, and recovery periods last from 48 hours to six months.

Erysipelas is the term used for a more superficial infection of the dermis and upper subcutaneous layer that presents clinically with a well-defined edge. (WIKIPEDIA)

CAUSES

Cellulitis is caused by a type of bacteria entering the skin, usually by way of a cut, abrasion, or break in the skin. This break does not need to be visible. Group A Streptococcus and Staphylococcus are the most common of these bacteria, which are part of the normal flora of the skin, but normally cause no actual infection while on the skin's outer surface.

Dental infections account for approximately eighty percent of cases of Ludwig's angina, or cellulitis of the submandibular space. Mixed infections, due to both aerobes and anaerobes, are commonly associated with the cellulitis of Ludwig's angina. Typically this includes alpha-hemolytic streptococci, staphylococci and bacteroides groups.^[1]

Predisposing conditions for cellulitis include insect or spider bite, blistering, animal bite, tattoos,pruritic (itchy) skin rash, recent surgery, athlete's foot, dry skin, eczema, injecting drugs (especially subcutaneous or intramuscular injection or where an attempted intravenous injection "misses" or blows the vein), pregnancy, diabetes and obesity, which can affect circulation, as well as burns andboils, though there is debate as to whether minor foot lesions contribute.

Occurrences of cellulitis may also be associated with the rare condition hidradenitis suppurativa.(WIKIPEDIA)

TREATMENT

Treatment consists of resting the affected area, cutting away dead tissue, and antibiotics (either oral or intravenous). Flucloxacillin or dicloxacillin monotherapy (to cover staphylococcal infection) is often sufficient in mild cellulitis, but in more moderate cases, or where streptococcal infection is suspected, then this course is usually combined with oral phenoxymethylpenicillin or intravenous benzylpenicillin, or ampicillin/amoxicillin. Pain relief is also often prescribed, but excessive pain should always be investigated as it is a symptom of necrotizing fasciitis. Elevation of the affected area is also important. As in other maladies characterized by wounds or tissue destruction, hyperbaric oxygen treatment can be a valuable adjunctive therapy, but is not widely available.