The cellulitis conundrum

The proper and timely treatment of a patient possesses potentially lifesaving benefits. In tandem, with the advancements in science & technology pertaining to the field of medicine, wondrous miracles have been performed during the past few decades. However the number of individuals receiving treatment due to Cellulitis continues to rise. This health condition is one of the most common causes for admission to the surgical wards in the government setup. In this week’s edition of Health Capsule we are joined by Dr. Thushan Gooneratne,  Senior Registrar in Vascular Surgery, who is currently on a vascular surgery fellowship in Leeds, UK to shed some light on the subject. Following are excerpts of an interview done with Dr. Gooneratne. 

QWhat is Cellulitis?
The condition called Cellulitis occurs when there is an infection on the skin and the layer of fat and tissues just below the skin surface. It can happen in almost any part of the body, but it’s more common in the legs. 

QWhat causes Cellulitis?
 Cellulitis is mainly caused by bacteria. Two types of bacteria called staphylococcus and streptococcus are commonly implicated. We all have bacteria, including these ones, living harmlessly on our skin. But our skin acts as a protective outer layer to prevent them from causing harm.  However, if there is any damage to our skin, then these bacteria can creep in and cause infection. I.e. cellulitis.

QHow do you recognise Cellulitis?
Commonly when there is cellulitis, the affected area becomes red, swollen and very painful. You will notice that the affected skin is tight, smooth and shiny. It feels very warm compared to the rest of the body.  It may initially be a small area, but will quickly enlarge in size within a few days.
If the bacteria enter the bloodstream, then you may also develop fever and chills. You may lose your appetite, feel nauseous and generally unwell. 

QWho are most susceptible to it?
Cellulitis can affect anyone.  In a normal healthy person, even if the infection gets in through the skin, the immune system is usually capable of destroying the bacteria before they spread the infection. Therefore cellulitis is not commonly seen in healthy adults and children. However certain conditions make some people more susceptible to developing cellulitis.

The elderly patients whose immune system is suppressed (i.e. on steroids, on chemotherapy, have immune deficiency medical conditions), patients who have skin conditions that cause cracks in the skin (eczema, cracked heal pads), patients who have poorly controlled diabetes and patients with chronic leg swelling have a higher chance of developing cellulitis. 

In fact, cellulitis may be the first presentation of a previously undiagnosed diabetic. So if you were otherwise healthy, it is important that you subject yourself to a fasting blood sugar test. Toe nail infections, fungal infections in toe web spaces, missed heal prick infections are commonly found causes of infection in such people. 

QWhat is the treatment for Cellulitis?
The mainstay treatment for cellulitis is antibiotics. This can be oral (if mild infection) or intravenous injections (if severe infection). Overall you will probably require 7-10 days of antibiotics. 

You can help speed up the healing process by resting the affected part and elevating it above the heart level. Drink plenty of water to prevent dehydration. Don’t attempt to rub various oils/creams/lotions and wrap bandages on the affected area. This can make things worse and result in permanent damage to the skin or cause ulceration.

Once the acute symptoms are controlled, it is important that the foci of infection as well as general predisposing conditions are properly treated to prevent cellulitis from recurring. Your doctor will perform the necessary investigations to find out such conditions.

QHow would you prevent it?
It is important that people exposed to the risk of cellulitis avoid skin damage. You should always try to wear protective clothing, shoes, gloves etc. whenever possible.

Patients with chronic limb swelling (due to varicose veins or lymphedema) should wear compression stockings. Sometimes if patients develop recurrent cellulitis despite all the prevention methods they are prescribed long-term antibiotics. It is important that people who are diabetic keep their blood sugar levels under control and have proper foot care. Don’t try to cut you own toe nails. Dry skin should be moisturised. Make sure that your shoes are not too tight and appropriate shoes are worn. Check your feet daily and immediately report any minor injury. 

QWhen should I be worried? What if things worsen?
It is important that you seek urgent medical attention, and not try to indulge in self-medication. There are many causes that mimic cellulitis. Your doctor will be able to differentiate them. 

Any cellulitis that involves the face and especially areas around the eye can result in brain infection called meningitis if not properly treated. Similarly if cellulitis involves genitalia, recent surgical sites or overlies a joint then you must seek immediate medical attention.  

If symptoms haven’t responded after 48-72 hours of antibiotics; or the skin colour changes from red to purple/brown or black colour, or if you notice blistering / numbness in the affected area, you should seek urgent medical attention. This could mean that the infection is spreading into deeper tissues, or resulting in a collection of pus and will require urgent surgery.  A dangerous condition called necrotizing fasciitis can develop when cellulitis progresses and is potentially fatal if surgery is delayed.
(The writer serves as MO Dialysis at the Base Hospital in Telliappalei)