CELLULITIS 

An inflammation of the deep dermal andsubcutaneous tissue that results from aninfectious process

 Local soft-tissue inflammatory reaction related tobacterial invasion of the skin.

Typeso 

Cellulities of the extremities- most commontype of cellulities

o 

Breast Cellulitieso 

Facial Cellulities (Erysipelas) medical attentionis urgent

o 

Leg Cellulitieso 

Orbital Cellulities can lead to permanent visionproblems

o 

Perineal Cellulities  around anal orifice

o 

Periorbital Cellulities around the eyes

Pathophysiology and Etiology

o 

Caused by infection with group A bet-hemolyticstreptococci, Staphylococcus aureus,Haemophilus influenza, or other organisms.

o 

Usually results from break in skin that may be assimple as athlete s foot because it keeps nopening to bacteria.

o

 Infection can spread rapidly through lymphaticsystem.

RiskFactorso 

Insect bites and stings , animal bite, or humanbiteo 

Injury or trauma with a break in the skin (skinwounds) o 

History of peripheral vascular diseaseo 

Diabetes -related or ischemic ulcerso 

Cracks or peeling skin between the toeso 

Use of immunosuppressive or corticosteroidmedicationsClinical Manifestations

o 

Tender, warm, erythematous, and swollen areathat is poorly demarcated.o 

Tender, warm, erythematous streak that extendsproximally from the area, indicating lymph vesselinvolvement.

o 

Possible fluctuant abscess or purulent drainage.o 

Possible fever, chills, headache, malaise.Diagnostic Evaluation

o 

 Appearanceof skin/ presence of signs andsymptoms

o 

Gram stain and culture of drainageo 

Blood cultures if generalized infectionssuspected

o 

CBC  may show an elevated WB

Cand indicates abacterial infection.

Management1. 

Oral antibiotics(penicillinase resistantpennicillins, cephalosporins, or quinolones )

maybe adequate to treat small, localized areas of cellulitis of legs or trunk.2. 

Parenteral antibioticsmay be needed forcellulitis of the hands, face or lymphatic orwidespread

involvement.3. 

Surgical drainage and debridementforsuppurative areas.

Complicationso 

Bone infection (osteomyelitis) o 

Inflammation of the lymph nodes (lymphangitis) o 

Sepsis, generalized infection and shocko 

Tissue death (gangrene) o 

Blood poisoningo 

Abscesso 

Facial cellulitis and meningitis

Nursing Assessment1. 

Obtain history of trauma to skin, insect bite, orwound.2. 

Observe for expanding borders and lymphaticstreaking; palpate for fluctuance of abscessformation.3.

 Watch for signs of antibiotic sensitivity shortness of breath, urticaria, angioedema,maculopapular rash, or severe skin reaction, suchas erythema

multiforme or toxic epidermalnecrolysis.4. 

Assess for patient and caretaker ability toprovide care at home, keep affected area clean,and adhere to medication prescribed.

Nursing Diagnoses 

Risk forImpaired Skin

Integrity r/t infectiousprocess 

AcutePain r/t inflammation of subcutaneoustissue.

Nursing InterventionsP rotecting Skin Integrity 

1. 

Administer, or teach patient to administer,antibiotics as prescribed; teach dosage schedulend adverse effects.2.

 Maintain

I.V. infusion or venous access toadministerI.V. antibiotics if needed.3.

 Elevate affected extremity to promote drainagefrom area and to minimize

swelling.4. 

Prepare patient for surgical drainage anddebridement, if necessary.Relieving pain

1. 

Encourage comfortable position andimmobilization of affected are.2. 

Administer analgesics as prescribed; monitor foradverse effects.3. 

Use bed cradle to relieve pressure from bedcovers.Patient Education and Health Mintenance

1. 

Be sure that patient understands dosageschedule of an antibiotics and the importance of complying with therapy to preventcomplications.2.

 Advise to notify health care provider immediatelyif condition worsens;3.

 Teach patient with impaired circulation orimpaired sensation, proper skin care

and how toinspect skin for trauma.Outlook (

Prognosis)It is possible to be cured with 7-10 days treatment.

Arellano UniversityCollege of NursingINTRODUCTION

Cellulitis is a spreading bacterial infection of the skin and tissues beneath the skin.Cellulitis usually begins as a small area of tenderness, swelling, and redness. As this red areabegins to enlarge, the person may develop a fever, sometimes with chills

and sweats, and swollenlymph nodes ("swollen glands") near the area of infected

skin.Cellulitis may occur anywhere on the body, but the leg is the most common site of theinfection (particularly in the area of the tibia or shinbone and in the foot), followed by the arm,and then the head and neck areas. In special circumstances, such as following surgery or traumawounds, cellulitis can develop in the abdomen or chest areas. People

with morbid obesity canalso develop cellulitis in the abdominal skin. Special types of cellulitis are sometimes designatedby the location of the infection. Examples include

periorbital (around the eye socket) cellulitis,buccal (cheek) cellulitis, and perianal cellulitis.The majority of cellulitis infections are caused by either staph (Staphylococcus) or strep(Streptococcus) bacteria. Staph (Staphylococcus aureus) is the most common

bacteria that causescellulitis. There is a growing incidence of community-acquired infections due to methicillin-resistant S. aureus (MRSA), a particularly dangerous form of these bacteria that is resistant tomany antibiotics and is more difficult to treat.Strep

(Streptococcus) is also a common cause of cellulitis. A form of rather superficialcellulitis caused by strep is called erysipelas; it is characterized by spreading hot, bright

redcircumscribed area on the skin with a sharp raised border. The so-called ³flesh eating bacteria"are, in fact, also a strain of strep that can sometimes rapidly destroy tissues.Cellulitis can be caused by many other types of bacteria. In children under 6 years of age,H. flu (Hemophilus influenza) bacteria can cause cellulitis, especially on

the face, arms, andupper torso. Cellulitis from a dog or cat bite or scratch may be caused by the Pasteurellamultocida bacteria, which has a very short incubation period

of only four to 24 hours.Aeromonas hydrophilia, Vibrio vulnificus, and other bacteria are causes of cellulitis thatdevelops after exposure to freshwater or seawater.

Pseudomonas aeruginosa is another type of bacteria that can cause cellulitis, typically after a puncture wound. 

 Cellulitis can affect anyone of any age; cellulitis of the face is more common in

childrenand adults over age 50 (Cunningham). The actual incidence of cellulitis is unknown becausecases are seldom reported. Orbital cellulitis is uncommon but

potentially very serious.The incidence of infection by methicillin-resistant Staphylococcus aureus (MRSA) andother antibiotic-resistant bacteria has increased

dramatically in recent years (Mayo Clinic Staff).Infection by these organisms is much more serious.

 14. 

Iris 

Round, brown symmetrical1

5. 

Ears 

Parallel, symmetrical, proportional to the size of the head 

Firm cartilage16. 

Nose 

In middle lie symmetrical and with discharge 

Internal nacres is pinkish17. 

Mouth 

Lips are pinkish, symmetrical with well defined 

Lips is smooth moist 

Gums has no swelling 

Tongue is pink, slightly rough on top and freelyrovable18. 

Neck  

Proportion to the size of the body and the head

 

Symmetrical and straight 

No palpable, lumps, masses or areas of tenderness 

Freely movable without difficulty19. 

Thorax and lungs 

Spine vertically aligned 

No retractions, wall intact 

Clear breath sound heard

 20. 

Abdomen 

Uniform in color and rounded 

Umbilicus centrally located 

Auscultation: audible bowel sound presence 

Percussion: tympany was noted on air  

Palpation: abdomen is relaxed with smooth tension no tenderness21. 

Upper extremities 

Fingers are equal in member, symmetrical and no abnormalities 

With blister and scars22. 

Lower extremities 

Skin has so many scars, blister and lesion 

Swelling erythema. 

         

 ANATOMY AND PHYSIOLOGY OF SKIN

 The

dermisis a layer of skin between the epidermis (with which it makes up the cutis)and

subcutaneous tissues, and is composed of two layers, the papillary and reticular dermis.Structural components of the dermis are collagen, elastic fibers, and extrafibrillar

matrix(previously called ground substance Theepidermis

is the outer layer of the skin , which together with the dermis forms thecutis. The epidermis is a stratified squamous epithelium, composed of proliferating basal

anddifferentiated suprabasal keratinocytes. The epidermis acts as the body's major barrier against aninhospitable environment.The

hypodermis,also called the hypoderm, subcutaneous tissue, or superficial fascia isthe lowermost layer of the integumentary system in vertebrates. Types of cells that are found inthe hypodermis are fibroblasts, adipose cells, and macrophages. It is derived from the mesoderm,but unlike the dermis, it is not derived from the dermatome region of the

mesoderm. Inarthropods, the hypodermis is an epidermal layer of cells that secretes the chitinous cuticle. 

 

Cellulitis Diagnosis

Most likely the doctor will make the diagnosisfrom a medical history and physical examination.

The doctor may also draw blood for testing if he or she feels the infection is severe enough to be in the bloodstream or to check for an elevated white blood cell count.

The doctor also may order an X-ray of the area if there is concern that a foreign object is in the skin or that bone underneath is infected.

The doctor may try to draw fluid from the affected area with a needle and send the fluid to the laboratory for a culture.

Cellulitis Treatment

Self-Care at Home

Rest the area of the body involved.

Elevate the area of the body involved. This will help decrease swelling and relieve discomfort.

Use over-the-counter pain relievers such as acetaminophen (Tylenol) oribuprofen (Advil, Motrin). This will decrease the pain as well as help keep the fever down.

Cellulitis pathophysiologyYou don't need to be Editor-In-Chief to add or edit content to WikiDoc. You can begin to add to or edit text on this WikiDoc page by clicking on the edit button at the top of this page. Next enter or edit the information that you would like to appear here. Once you are done editing, scroll down and click the Save page button at the bottom of the page.

Cellulitis Microchapters

Home

Patient Info

Overview

Pathophysiology

Epidemiology & Demographics

Risk Factors

Causes of Cellulitis

Differentiating Cellulitis from other Diseases

Natural History, Complications & Prognosis

Diagnosis

History & Symptoms

Physical Examination

Lab Tests

Treatment

Medical Therapy

Primary Prevention

Cellulitis pathophysiology On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of

Cellulitis pathophysiology

All Images

X-rays

Echo & Ultrasound

CT Images

MRI

Ongoing Trials

at Clinical

Trials.gov

US National

Guidelines

Clearinghouse

NICE Guidance

FDA on

Cellulitis

pathophysiology

CDC on

Cellulitis

pathophysiology

Cellulitis

pathophysiology

in the news

Blogs on

Cellulitis

pathophysiology

Directions to

Hospitals

Treating

Cellulitis

Risk calculators

and risk factors

for Cellulitis

pathophysiology

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753; Associate Editor(s)-In-

Chief: Aditya Govindavarjhulla, M.B.B.S.

Overview

Cellulitis results in activation of the body's inflammatory response mechanisms. When the immune

system cannot respond adequately, it can spread systemically through the blood stream.

Pathophysiology

Microorganisms gain initial access into the layers of the skin through the discontinuities or cuts in the skin.

The body responds to these microbes as a foreign bodies, and this causes an inflammatory response.

This leads to redness, swelling, pain and itching of the area involved. A local infection leads to

inflammation of the area. With a competent immune system, the spread of the infection is limited. If the

immune system fails to curb the infection it may become systemic by spreading into the adjacent areas

and may finally enter the blood stream causing (Bacteremia).

References

Leg CellulitisLeg cellulitis is a skin infection caused by a few different types of bacteria. Risk factors for the condition include obesity, skin ulcers, and swelling of the leg. Symptoms can be either localized or systemic, but redness, heat, and swelling are typically seen. Leg cellulitis is most commonly treated with antibiotics. Keeping the affected leg elevated and applying cold compresses can help relieve pain.

An Introduction to Leg CellulitisLeg cellulitis is a skin infection on the leg that is characterized by swelling, redness, warmth, and pain. It affects people of all ages and can occur anywhere on the body. However, cellulitis mostly affects the legs, feet, arms, and hands. These types of cellulitis are commonly referred to as "cellulitis of the extremities."

 

Causes of Leg CellulitisLeg cellulitis is an infection caused by bacteria. The most common cause of this condition in adults with no medical conditions is group A streptococcus, which is a bacterium commonly found in the throat and on the skin.

 

Another common cause of leg cellulitis in adults is Staphylococcus aureus (S. aureus), which is a bacterium that is commonly found on human skin and mucosa (lining of mouth and nose).

 

The most common cause of leg cellulitis in children under the age of three is Haemophilus influenzae type B, which is a bacterium that causes serious infections.

 

Leg Cellulitis (Cont.)Risk Factors for Leg CellulitisCellulitis research has shown that people with certain risk factors are more likely to develop leg cellulitis than others. Common risk factors for the condition include:

 

Problems with the lymphatic system

Vein problems

Swelling of the leg

Breaks in the skin

Obesity.

 Specific risk factors include:

 

Surgical wounds

Skin  ulcer (such as a diabetic ulcer)

Eczema, psoriasis, or other skin conditions that may cause a break in the skin

A previous episode of cellulitis

Surgery to remove lymph nodes

Radiation therapy

Coronary artery bypass surgery

IV drug use

Chemotherapy

Pregnancy

Certain conditions, including diabetes, HIV or AIDS,leukemia, lymphoma, psoriasis, dyshidrosis, lupus, andheart failure.

 

While these risk factors are not actual causes of leg cellulitis, they do increase a person's chances of developing it. People who believe that they may be at risk for leg cellulitis should discuss this concern with their healthcare provider.

 

Symptoms of Leg CellulitisSymptoms of leg cellulitis can occur at the location of the infected skin (local symptoms) or they can occur on other parts of the body (systemic symptoms).

 

(Click Cellulitis Symptoms for more information.)

 

Leg Cellulitis Article Continues on Next Page >

Leg Cellulitis (Cont.)Diagnosing Leg CellulitisYour healthcare provider typically makes a leg cellulitis diagnosisby asking questions about your medical history, performing a physical exam, and ordering blood tests. The most reliable way of diagnosing leg cellulitis is by looking at the affected area. An area affected by cellulitis will be:

 

Red

Warm to the touch

Swollen

Painful.

 Your healthcare provider will also look for breaks in your skin (such as cuts, bruises, scrapes, skin conditions, or ulcers) where bacteria could have entered. He or she will likely also order a blood test to see if there is any indication of an infection.

 

Treating Leg CellulitisTreatment for leg cellulitis is aimed at healing the affected area and any underlying conditions that may increase the likelihood of a recurrence. Specific treatment options include medications and recurrence prevention.

 

Antibiotics are usually the first line of treatment, so tell your doctor if you are allergic to penicillin. During treatment for leg cellulitis, you should keep the affected leg elevated and use cold compresses to help reduce pain. However, 50 percent of people who receive treatment experience a recurrence of leg cellulitis. If this happens, your healthcare provider may prescribe antibiotics for a longer period of time.