Cellulitis
Cellulitis is an infection of the dermis or subcutaneous layer of the skin. It may follow damage to the skin, such as a bite or wound that allows infiltration by an infectious organism. The invading organism overwhelms the defensive cells (neutrophils, eosinophils, basophils, and mast cells) that normally contain and localize inflammation and continues its spread beyond the initial wound and into the surrounding tissue. Fever, erythema, and lymphangitis may occur as cellulitis continues its progression into previously healthy tissue.
If treated in a timely manner, the prognosis for this condition is good. However, patients with coexisting conditions, such as diabetes, immunodeficiency, and impaired circulation have an increased risk for developing or advancing cellulitis.
Cellulitis occurs most commonly in the lower extremities and affects males and females equally.
Causes
Cellulitis often occurs due to bacterial or fungal infections; group A streptococcus and Staphylococcus aureus are the most common causative agents. Extension of a skin wound, ulcer, furuncle, or carbuncle and progression to infection may also result in cellulitis.
Complications
Possible complications of cellulitis include its spread to surrounding tissue, localized abscesses, and thrombophlebitis. Untreated cellulitis may result in sepsis. Lymphangitis may occur in patients with recurrent cellulitis.
Assessment
The patient’s history may reveal one or more risk factors for cellulitis, such as venous and lymphatic compromise, edema, diabetes mellitus, underlying skin lesions, and prior trauma. Other assessment findings may include tenderness or pain in the affected area, chills, and malaise.
Physical findings include erythema with indistinct margins, fever, warmth and tenderness of the skin, regional lymph node enlargement and tenderness, and red streaking visible in skin proximal to the affected area.
Assess the patient’s mobility status if the cellulitis is located in a lower extremity. Poor mobility puts the patient at risk for injury and may create self-care deficits. Assess the patient’s level of pain and determine whether it increases or decreases with movement, positioning, or performing routine activities. Assess for signs of sepsis or deep vein thrombosis that may arise from cellulitis.
Elderly patients who have cellulitis in a lower extremity should also be assessed for thrombophlebitis.
Diagnostic tests
Diagnosis of cellulitis is based upon the following findings:
Visual examination and inspection
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
