Cellulitis - Pictures, Symptoms, Treatment, Contagious, Causes, Types
What is Cellulitis?
Cellulitis is a bacterial infection of the skin involving the tissue of the deeper layer of the skin both the dermis and subcutaneous tissue. It is a common infection that can be potentially serious as the infection can spread and invade the lymph nodes and enter the bloodstream however, cellulitis is an infection considered to be non-purulent or one that does not form an abscess. Cellulitis often appears in areas with broken skin such as those that created by skin ulcer or wounds from surgical incision.
Cellulitis is apparently an unreported disease that its prevalence remains vague although it is somewhat a common infection that can happen to anybody. No racial and ethnic group predilection or gender has been reported with the epidemiology of cellulitis although it has been seen to commonly affect adults over the age of 50 years old especially with facial cellulitis while children below the age of 3 years old are commonly affected with perianal cellulitis. The development of cellulitis in elderly however, has made them predisposed for developing thrombophlebitis. Cellulitis on the other hand can be potentially life-threatening when the infection continues to spread and affect the lymphatic and circulatory system.
Cellulitis is characterized with skin swelling and redness of skin of the affected area while the skin may feel hot and tender to touch. It initially starts with tenderness, redness and swelling of the skin on the affected area and spread to adjacent area of the skin. The reddened area of the skin will expand overtime while small red spot may also develop over the redness and which may form blisters that burst in time. Fever may develop while the skin redness gradually increases its size and the enlargement and fever may also be associated with chills, sweating and palpable swollen lymph nodes adjacent to the areas of infection.
Cellulitis on the other hand has different types named according to the areas of infection while each has different presentation from another although there may be some similarity.
Common types of Cellulitis
Extremity cellulitis is a type of cellulitis that occurs either in the arm or in the leg. The mode of bacterial infection is through a break in the skin surface with symptoms including:
- Arm or leg tenderness
- Pain and swelling over the affected area
- Redness of the affected skin
- Affected skin is warm to touch and red spots may develop over the redness
- Fever associated with chills and sweating may occur especially in severe cases
- Palpable swollen lymph nodes adjacent to affected skin.
Facial cellulitis usually occurs in adults aged 50 years and above especially to those with compromised lymphatic systems or to those suffering from upper respiratory infections. The symptoms in this type of cellulitis include the following:
- Tenderness of the face, lips or tongue associated with skin redness
- Pain and swelling of the affected area
- Onset of fever and chills
- Skin of the face may feel tight and warm to touch.
Periorbital cellulitis is also called preseptal cellulitis that affects the eyelid and the skin surrounding the eyes. This type of cellulitis however, does not affect the movement of the eye and generally not a serious condition although the visual can be obscured. It is often the consequence of trauma or damage to the eye and may also be the result of another infection such as sinusitis. The symptoms of this type of cellulitis include the following:
- Redness and swelling of the skin of the eyelid or the skin surrounding the affected eye
- Pain and tenderness of the affected eye
- Fever may develop
Orbital cellulitis is a rare type although far more dangerous due to its potential to spread in the brain. It is often secondary from an infection in the sinus and it affects the skin lining of the eye socket while it is the result of an injury to the eye. The symptoms of this type of cellulitis include the following:
- Inflammation of the eyelid and the areas around it
- Pain and discomfort over the affected eye
- Affected eye bulges or may have restriction in the eye movement
- Diminished vision
- Onset of high fever
Perianal cellulitis generally affects young children aged 3 years and below and is often caused by Group A Streptococcus. This type of cellulitis is also known as perineal dermatitis and characterized by erythema of the perianal that extends from 2 to 3cm in the anal border. Symptoms of this cellulitis include the following:
- Redness of the anal skin
- Painful and itchy bowel movement which may sometimes be associated with bleeding
- Onset of fever
Erysipelas is a type of cellulitis that affects the superficial skin and is mainly the result of gas produced by the bacteria. This type of cellulitis is also called St. Anthony’s fire or holy fire. Symptoms include the following:
- Onset of high fever associated with chills
- Skin lesion is marked by a raised border
- Skin beneath the lesion is very swollen and reddish and warm to touch
- Affected area is painful
- Development of erysipelas lesion over the bridge of the nose and the cheeks.
There are numerous bacteria that can cause cellulitis although majority of cases is often an infection from Staphylococcus aureus or Streptococcus pyogenes.
Common bacteria causing cellulitis
- Staphylococcus aureus including the methicillin resistant strains which is potentially dangerous due to its property of resistance to antibiotic and methicillin treatment.
- Beta-hemolytic streptococci are the most common bacteria that cause cellulitis.
- Haemophilus influenza commonly infects children below the age of 3 years old and commonly occur in the face, arms and upper torso.
- Clostridium perfringens causes bacteria to produce gas when infection spreads in the muscle.
- Pasteurella multocida is a bacterial infection from the bite of cat or dog.
- Aeromonas hydrophilia is bacteria acquired from injury in freshwater.
- Vibrio vulnificus is bacterial infection from exposure to saltwater and is potentially life-threatening to patient suffering from certain type of chronic liver disease.
Predisposing factors for cellulitis
- Surgical wound or incision
- Break in the skin from trauma, puncture, laceration
- Break in the skin from animal bites or sting
- Skin lesions and ulcerations
- Compromised immune system
- Addiction from intravenous drug
- Constant use of steroid drugs
- Occupational exposure such as farmers, gardeners and fish handlers.
Cellulitis can be treated as out-patient although severe cases require hospitalization although the infection is generally treatable and without result of lasting disability. It is usually treated with prescription of oral antibiotics depending on the type of bacterial infection while others may require intravenous antibiotics especially when the patient is not responding to oral medication which condition usually progresses after three days from initial treatment. The goal of treatment on the other hand is in reducing the severity of infection and to relieve the symptoms while speeding up recovery and skin healing and in prevention of recurrence.
Surgical intervention is not an immediate recommendation except when there is already a formation of abscess or pus in the tissue and drainage is the option to allow relief of pain while removal of dead tissue is necessary to allow skin healing.
Self-care treatment can also be done at home such as:
- Elevation of affected part of the body to reduce swelling
- Sufficient rest of the part of the body infected by the bacteria
- Pain relievers which can be bought over-the counter.
Is Cellulitis Contagious?
Cellulitis is generally not a contagious disease as the invasion or infection of bacteria is mainly in the deeper layers of the skin such as that of the dermis and subcutaneous tissue. The top layer of the skin or the epidermis is not included in the infection and it provides protection while enveloping the infection and therefore cannot be transmitted from one person to another.
Although treatable and generally not contagious, cellulitis when left untreated is potentially dangerous and life-threatening while it can also result to other medical complications such as:
Meningitis is potentially at risk in facial cellulitis especially when the infection has spread to the membranes or meninges of the brain.
Blood poisoning secondary to cellulitis is potential when bacterial infection has reached the bloodstream.
Abscess or the collection of pus from cellulitis is the result of bacterial buildup or buildup from dead white blood cells.
Thrombophlebitis occurs when cellulitis has disrupted blood circulation which can lead to blood clots.