cellulitis

(sel″yŭ-līt′ĭs)

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[cellula + -itis,]
A spreading bacterial infection of the skin and subcutaneous tissues, usually caused by streptococcal or staphylococcal infections in adults (and occasionally by Haemophilus species in children). Cellulitis differs from a skin abscess because in a skin abscess there is a focal and drainable collection of pus; in cellulitis the infection is more diffuse. Cellulitis may occur following damage to skin from an insect bite, an excoriation, or other wound. The extremities, esp. the lower legs, are the most common sites. Adjacent soft tissue may be involved. Affected skin becomes inflamed: red, swollen, warm to the touch, and tender. Spread of infection up lymphatic channels may occur. Cellulitis involving the face is called erysipelas. When it affects the lower extremities, cellulitis must be differentiated from stasis dermatitis, which is associated most commonly with bilateral, chronic dependent edema and, occasionally, with deep venous thrombosis. Risk factors for cellulitis include diabetes mellitus, lymphedema, venous stasis or insufficiency, immune suppression, injection drug use, malnutrition, peripheral vascular disease, and previous skin diseases.
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CELLULITIS ; SEE: necrotizing fasciitis

ETIOLOGY
Bacteria gain access through breaks in the skin and spread rapidly, overwhelming normal body defenses; lesions between the toes from athlete's foot are common entry sites.

TREATMENT
For mild cases of cellulitis, oral antibiotics may be effective depending on the causative organism. For severe cases, intravenous penicillinase-resistant penicillins are used; surgical débridement to obtain cultures and to rule out fasciitis is recommended for patients with diabetes.

Descriptive text is not available for this imageRarely, group A streptococcal cellulitis may be complicated by exfoliative dermatitis or infection of the subcutaneous fat and fascia, causing necrosis (necrotizing fasciitis), a condition popularly ascribed to the action of “flesh-eating bacteria.”

PATIENT CARE
Blood cultures should be obtained from patients with cellulitis to assess for sepsis before beginning therapy with antibiotics. The affected body part should be elevated above the level of the heart. Outlining the affected area with a skin marker allows the caregiver to readily determine if inflamed tissues are responding to therapy. Size, shape, color, and temperature of the affected area and surrounding tissues should be documented and any drainage described. Applying warm soaks to the area increases vasodilation, thus decreasing edema and relieving pain. Pain should be treated with prescribed oral analgesics and anti-inflammatory drugs. Blood sugars, if elevated, should be lowered to normal levels (preferably about 126 mg/dL or less). Patients on prolonged bedrest should be given heparin to prevent deep venous thrombosis as well as stool softeners to prevent constipation. Patients who develop cellulitis are often at risk for recurrence; they should learn general skin hygiene, how to clean cuts, scratches, cracked skin, and abrasions, and the importance of prompt treatment for infections.

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Facial cellulitis right side
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FACIAL CELLULITIS RIGHT SIDE

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