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Cellulitis

Introduction

What should I know about Cellulitis?

No, we are not talking about a condition related to obesity. Our obsession with weight has brought about confusion in regard to how many of words are used. Contrary to what most people think, you do not have to be overweight to have cellulitis. And, cellulitis is not to be confused with the cosmetic concern known as cellulite. Cellulitis is a serious condition. It is generally an acute, spreading infectious process that initially affects the layers of the skin and then may spread within the layer of connective tissue that lies just below the surface of the skin called the superficial fascia. (1) Infections of the skin and soft tissue are among those most commonly seen both in and out of the hospital setting.

Cellulitis is considered a serious condition because of the tendency for it spread through the lymphatic system and then into the bloodstream. Bacteremia may be present in as many as 30 percent of cases. Other complications include the possibility of thrombophlebitis, particularly in the elderly population.

The skin and tissues just under the skin are normally extremely resistant to infection. Even when high concentrations of bacteria are applied topically or injected into the soft tissue, it is rare for an infection to take hold. (2)

Our skin is a tough barrier to infection and there are several reasons for this. The surface of the skin is usually a pretty dry place so it is not really the environment that makes a good home for bacteria. Also, the skin continues to renew itself by shedding cells and along with them, bacteria. Any situation that changes the normal condition on the skin, our largest organ, puts it in danger of becoming infected. Some of these conditions include abrasions, disease, punctures, and various infections. The areas of the body that are most sensitive to infection are the areas which are generally exposed such as the face, neck, and hands. These areas usually have the highest bacterial density. Cellulitis is usually caused by two microorganisms known as Streptococcus pyogenes or Staphylococcus aureus. There are other types of organisms which can cause cellulitis that could be seen in patients with diabetic foot problems. This infection is much more complicated. Finally, one of the more exotic possible ways to get cellulitis would be through an insect bite such as the bite of a brown recluse spider. Finally, dry, cracked skin that remains uncared for may become secondarily infected. (3)

One particular type of cellulitis occurs in children between the ages of one and five years. This is known as Haemophilus influenza. This type of cellulitis is often associated with an upper respiratory infection and involves the face, neck, or upper extremities. In children, the lesions are usually blue-red or purple-red and are swollen.

Statistic

The Center for Disease Control, 1998.

    Approximately 13.3 per 10,000 of population were admitted to hospitals for problems related to cellulitis.

Signs and Symptoms

The following list does not insure the presence of this health condition. Please see the text and your healthcare professional for more information.

Cellulitis symptoms appear as very general complications and problems. At the site of the sore is redness and swelling. The area is painful, non-elevated and has a poorly defined border. The lymph glands may be tender and swollen. The individual usually feels tired and has a fever and chills. Usually there is a history of a prior wound in that area of the body.

Other complications include infection and the possibility of blood clots in lower legs, particularly in the elderly population with cellulitis in the same area.

General complications

  • Redness
  • Swelling
  • Area is painful, non-elevated, with poorly defined border
  • Tender swelling of lymph glands are common
  • Tiredness
  • Fever
  • Chills
  • Usually there is a history of a prior wound in that area of the body

Other complications

  • Infection
  • Possibility of blood clots in lower legs, particularly in the elderly population with cellulitis in the same area

Treatment Options

Conventional

The overall goal of treatment is to get rid of the infection and prevent further complications. Local treatment of cellulitis may include elevating the area infected and trying to keep that area immobile in order to decrease swelling. Cool bandages soaked in a saline solution followed by a moist heat treatment may aid in localizing the infection. If antimicrobial therapy such as an antibiotic is used, the type used depends on which bacteria are suspected to be present. Sometimes, distinguishing these tiny microbes apart cannot be done without a skin or blood culture. Usually semi-synthetic penicillin such as nafcillin or oxacillin may be used. Mild to moderate infections without symptoms that indicate the infection has not spread through the body may be treated orally with dicloxacillin. More severe infections, either staphylococcal or streptococcal, should be initially treated with intravenous antibiotic regimens. (4) The majority of patients respond rapidly when treated promptly with the appropriate antibiotic. Non-response may be indicative of an underlying local or systemic problem or misdiagnosis.

For people who are allergic to penicillin, erythromycin may be used. Drugs that might be used include the following: cephalosporins such as cefazolin cefadroxil, cefaclor and cefpodoxime proxetil, (5) methicillin vancomycin, ceftriaxone, (6) carbapenems b-lactamase inhibitor, fluoroquinolones, amoxicillin, and ampicillin.

Nutritional Suplementation


Lactobacillus, Bifidobacteria

Since antibiotics are commonly used to treat cellulitis, patients who have undergone antibiotic therapy should be advised to undergo a course of probiotic supplementation with L. acidophilus or a combination of lactobacillus organisms along with bifidobacteria in order to insure a healthy gut micorflora.

Herbal Suplementation


Gotu Kola

Gotu kola is believed to have healing activity in the body. It is claimed to have a positive effect on tissues, specifically skin, connective tissue, lymph and mucous membranes. (7) , (8) , (9) Gotu kola has been used topically for soft tissue inflammation and infection, and for post surgical wound healing. (10) , (11)

It is believed to have an effect on keratinization, which aids in thickening skin in areas of infection. (12) Based on these actions, gotu cola may be beneficial in the management of cellulitis.


Horse Chestnut

Horse chestnut has a chemical in it called aescin which when taken by mouth can be 100 times more powerful than bioflavinoids as an anti-inflammatory, and reduces local edema by reducing capillary permeability to water, thereby decreasing the flow of fluids into the cells. (13) , (14) This makes horse chestnut preparations potentially beneficial in the management of cellulitis.

References

  1. Danzinger LH, Fish DN. Skin and Soft Tissue Infections, In:DiPiro JT, et al. eds. Pharmacotherapy, A Pathophysiologic Approach. 4th ed. Appleton & Lange. Stamford CT. 1999:1685-1689.
  2. Yagupski P. Bacteriologic aspects of skin and soft tissue infections. Pediatr Ann. 1993;22:217-224.
  3. View Abstract: Lipsky BA, Pecoraro RE, Wheat LJ. The diabetic foot: Soft tissue and bone infection. Infect Dis Clin North Am. 1990;4:409-432.
  4. View Abstract: Hook EW, Hooten TM, Horton C, et al. Microbiologic evaluations of cutaneous cellulitis in adults. Arch Intern Med. 1986;146:295-297.
  5. View Abstract: Sadick NS. Current aspects of bacterial infections of the skin. Dermatol Clin. 1997;15:341-349.
  6. View Abstract: Dagan R, Moshi P, Watemberg N, et al. Outpatient treatment of serious community-acquired pediatric infections using once daily intramuscular ceftriaxone. Pediatr Infect Dis J. 1987;6:1080-1084.
  7. View Abstract: Suguna L, et al. Effects of Centella asiatica Extract on Dermal Wound Healing in Rats. Indian J Exp Biol. 1996;34(12):1208-11.
  8. View Abstract: Hausen BM. Centella asiatica (Indian Pennywort), an Effective Therapeutic But a Weak Sensitizer. Contact Dermatitis. 1993;29(4):175-79.
  9. View Abstract: Tenni R, et al. Effect of the Triterpenoid Fraction of Centella asiatica on Macromolecules of the Connective Matrix in Human Skin Fibroblast Cultures. Ital J Biochem. 1988;37(2):69-77.
  10. View Abstract: Maquart FX, et al. Stimulation of Collagen Synthesis in Fibroblast Cultures by a Triterpene Extracted from Centella asiatica. Connect Tissue Res. 1990;24(2):107-20.
  11. View Abstract: Cesarone MR, et al. The Microcirculatory Activity of Centella asiatica in Venous Insufficiency. A Double-blind Study. Minerva Cardioangiol. 1994;42(6):299-304.
  12. View Abstract: Poizot A, et al. Modification of the Kinetics of Healing after Iterative Exeresis in the Rat. Action of a Triterpenoid and Its Derivatives on the Duration of Healing. C R Acad Sci Hebd Seances Acad Sci D. 1978;286(10):789-92.
  13. View Abstract: Rothkopf M, et al. Proceedings: Further Results on the Efficacy and the Mode of Action of the Horse Chestnut Saponin Escin. Arzneim-Forsch/Drug Res. 1976;26(2):225-35.
  14. View Abstract: Guillaume M. Veinotonic effect, vascular protection, antiinflammatory and free radical scavenging properties of horse chestnut extract. Arzneimittelforschung. Jan1994;4(1):25-35.