What is Cellulitis?
Cellulitis is an inflammation of the cells of the subcutaneous (beneath the skin) tissue. The inflammation is secondary to a bacterial invasion of the skin.
Quickcare or ER?
Red Flags that will send you to the ER:
- Fever, chills
- Severe pain.
- Red Streaks from the Cellulitis
Your doctor will want to know your symptoms. Remember, SYMPTOMS are your words describing your condition. It is your story.
For example, a cellulitis symptom may be your complaint of redness or swelling.
Answers to the following questions will help your doctor understand.
When did it start?
What made it better?
What made it worse?
How bad is the pain?
Symptoms of a staph infection may be like a cellulitis.
What is your doctor looking for?
Your doctor will look for signs. A SIGN is an objective finding that a doctor discovers during the examination.
An attending once told me, “vital signs are vital” So simple yet so profound. In other words, look toward the basics first. This will indicate if a bigger problem is lurking in the background.
Specifically, your doctor should look at the temperature and heart rate. Do you have a fever? A fever and cellulitis puts a patient at a much higher risk of severe illness.
Also, a skin infection can develop into an abscess.
Then, observe the skin. To note is if there is local redness and swelling or red streaks.
Ultrasound has played a key role in the diagnosis of a more severe form of cellulitis called necrotizing infection. Given its rapid progression, an early diagnosis is key.
What is your doctor thinking?
Redness. Swelling. Fever.
A doctor could consider a skin fungus as a cause of the skin condition.
High on the list is a bacterial infection.
Then the next question is if the skin infection spread into the blood (bacteremia).
Another consideration is erythema nodosum which is an inflammation of the fat tissues under the skin. Causes include an infection, an autoimmune disease, or a reaction to a medication. Sometimes erythema nodosum occurs for no reason.
Another thought is if the bacteria from the skin went into the knee joint (septic arthritis). In both cases, a simple prescription is not good enough.
For children with cellulitis, your doctor will consider impetigo. What is impetigo? It is a bacterial infection, often seen on the face,causing honey-crusted lesions. (see photo above).
What is the treatment of a cellulitis?
Antibiotics treat cellulitis.
Around 6-8 years ago, there was an explosion of cellulitis caused by a bug called MRSA ( methicillin resistant staph aureus). Some pronounce MRSA as “mersa.” Most patients just assume it was a bug bite.
The treatment for MRSA is Bactrim 500 mg twice a day for one week. If there is a sulfa allergy then Clindamycin is a good alternative. Usually patients are kept on this medication for at least one week.
How long will you be sick?
In general, an infection will last about a week.
When a patient has a cellulitis, many times I will draw a line around its periphery. I tell patients, ” if the redness goes beyond the line, return to the ER with a toothbrush since you will be admitted.” That usually gets patients to be compliant with the antibiotics.
Be careful. If it spreads to the joint then this is very bad. This is called a septic joint and needs admission.
Let me tell you a story
“It started as a pimple so I popped it,” said Abel. Ok. That sounds innocent. I have popped many a zit without going to the doctor shortly thereafter.
For Abel, this was different. The pimple was on his knee and he worked in the fields. So, now he had an open wound that was exposed to dirt all day. On top of that, he was kneeling on the open wound. Naturally, he pushed the grime into his skin. That can’t be good.
I asked,” Well, what’s bothering you now.?”
“Ah, man. I feel so achy and feverish. And the pimple turned into all kinds of puffiness at my knee.”
In Abel’s case, the pimple started 5 days ago. He used hot compresses without relief. The pimple grew into a huge red swelling all around the knee. Nothing specific made it grow. On a scale from 1-10, his pain was an 8. Key is that the pain felt like it was “inside” and it is hard for him to walk.
On exam, his temperature was high with a fever. This made his heart rate go up.
Although Abel said it was painful with walking, he walked without any major difficulty. This is key since an infection in the knee joint makes it very painful to walk.
So, let’s put it together. Abel has a fever and a red, swollen knee but can walk. Luckily, there are no red streaks springing from the infection
Abel is not allergic to sulfa drugs, so he was able to take Bactrim. But, given his fever, he was given a shot of Rocephin in the clinic.
At the next visit, he had no fever, diminished skin redness and was walking without difficulty.
I hope this helps
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