Cellulitis

Surgery > Cellulitis

Summary
Description

Cellulitis is a spreading, acute inflammation of the dermis and subcutaneous tissue, sometimes involving muscle. There is considerable overlap in presentation between various skin and soft tissue infections, and many have a cellulitic component. Hallmarks are erythema, edema, tenderness, and warmth Erysipelas, a streptococcal infection involving the superficial layers of the dermis, is characterized by a well-demarcated raised area of vivid erythema; the more common appearance of cellulitis is one of varying degrees of erythema and poorly defined margins. The degree of associated systemic illness is variable Cellulitis most frequently occurs on the head and neck in children, and the lower extremities in adults. Also found on the scalp, the perianal area, or complicating surgical incisions, sites of chronic or traumatic wounds, burns, or bites inflicted by animals or humans (including closed fist wounds) Patients most likely to develop cellulitis are those with diabetes (type 1 and type 2), immunodeficiency diseases, previous cellulitis, venous and/or lymphatic compromise, alcoholism, intravenous drug abuse, and peripheral vascular disease

Synonyms
Erysipelas (in common usage as a synonym, though technically used to refer to the unique presentation of streptococcal infection described above).

Immediate action

Check for signs of necrotizing infection: edema extending beyond area of erythema, bullae formation, skin anesthesia, crepitus, discoloration affecting an entire limb or at a distant site on the same limb or elsewhere, extremely toxic appearance of patient Immediate hospitalization and aggressive surgical management is required for necrotizing infection Rapid hospitalization is also required for deep and quickly spreading infections, particularly those on the face or hand, and for patients with severe infection and systemic signs of sepsis (high fever or hypothermia, tachycardia, hypotension) Hospitalization should be considered for patients with underlying disease, such as diabetes mellitus, severe peripheral vascular disease, or immune dysfunction

Key points

Cellulitis is a spreading, acute inflammation of the dermis and subcutaneous tissue, sometimes involving muscle. Hallmarks are erythema, edema, tenderness, and warmth Risk factors include diabetes mellitus (type 1 and type 2), immunocompromised state, alcoholism, intravenous drug abuse, and a prior history of cellulitis. A history of surgery resulting in disrupted lymphatic drainage predisposes to recurrent episodes (eg, saphenous

vein harvesting for coronary artery bypass grafting or mastectomy and axillary node dissection) The infectious agent is most frequently Streptococcus pyogenes or Staphylococcus aureus First-line therapy includes oral antibiotics with good coverage of Gram-positive organisms Outpatients placed on oral antibiotic therapy should be re-evaluated 24 to 48 hours after starting therapy to assess response to therapy Suspected necrotizing infection, deep or quickly spreading infection (particularly on the face and hands), and orbital cellulitis require referral for further investigation and treatment

Background
Cardinal features

Acute, spreading inflammation of the dermis and subcutaneous tissues Muscle may also be affected Affected areas are warm, red, edematous, and tender; there may be associated suppuration Lymphatic streaking and lymphadenopathy may be present Most frequently occurs on the head and neck in children, and lower extremities in adults. In intravenous drug abusers, the upper extremities are often involved Can affect traumatic wounds, burns, animal bites, and surgical incisions Patients most frequently affected are those with diabetes (type 1 and type 2), immunodeficiency diseases, previous cellulitis, venous, and/or lymphatic compromise, peripheral vascular disease, alcoholism, and intravenous drug abuse The infectious agent is most frequently Streptococcus pyogenes or Staphylococcus aureus In the past, the most common infectious agent among children was Haemophilus influenzae, but since the introduction of the Hib vaccine (H. influenzae type b), these infections are now less common

Causes
Common causes

Group A -hemolytic streptococci (Streptococcus pyogenes) Staphylococcus aureus Haemophilus influenzae (decreasing in frequency) Group B, C, D, or G -hemolytic streptococci
Rare causes

Certain circumstances and host characteristics suggest infection with unusual organisms:

Aerobic Gram-negative bacilli, including Escherichia coli and Pseudomonas aeruginosa (may occur with granulocytopenia, diabetic foot ulcers, severe tissue ischemia, and institutionalized patients) Streptococcus agalactiae (patients with diabetes mellitus or peripheral vascular disease) Streptococcus pneumoniae (in peri-orbital cellulitis) Helicobacter cinaedi (patients with immune deficiency) Pasteurella multocida (cat and dog bites) Staphylococcus intermedius (dog bites) Capnocytophaga canimorsus (dog bites) Eikenella corrodens (animal bites and human bites) Bacteroides species (animal bites and human bites) Peptostreptococcus (human bites)

Aeromonas hydrophila (injuries in freshwater lakes, rivers, and streams) Vibrio vulnificus (injuries in salt water; patients with certain forms of chronic liver disease are especially susceptible and can develop rapidly progressive, life-threatening infection) Erysipelothrix rhusiopathiae (injuries from saltwater fish; also transmitted by farm animals) Pseudomonas aeruginosa (cellulitis involving the ear, including malignant otitis externa in diabetic patients and infected cartilage piercings; also occurs in needlestick infections in intravenous drug users and may complicate reptile bites. Commonly implicated in infections contracted by stepping on a nail while wearing a sneaker; these infections frequently and rapidly evolve into osteomyelitis. Hot-tub folliculitis is a syndrome of folliculitis and cellulitis in the distribution of hot-tub immersion, caused by P. aeruginosa and associated with inadequately cleaned hot-tubs) Mycobacterium marinum (injuries in aquariums or swimming pools) Mixed aerobic-anaerobic flora (suspected in synergistic necrotizing cellulitis) Enterobacteriaceae (suspected in intravenous drug users; common in cellulitis complicating diabetic foot infections) Enterococcus (in diabetic foot infections and cellulitis associated with decubitus ulcers) Fungi, including mucormycosis and aspergillosis (suspected with immunocompromised hosts and intravenous drug users) Atypical mycobacterium (suspected with immunocompromised hosts) Clostridium perfringens (may cause gas-forming cellulitis) Tuberculosis Syphilitic gumma
Serious causes

Group A streptococci (several strains may cause severe infections leading to shock, multisystem organ failure, and death) Haemophilus influenzae (may be associated with gas formation or purulent collections. In non-vaccinated children younger than 3 years who lack an obvious portal of entry, meningitis should be considered) Clostridium perfringens (may cause gas gangrene if infection spreads to muscle) Mixed aerobic-anaerobic flora (suspected in synergistic necrotizing cellulitis) Vibrio vulnificus (can cause life-threatening infections in patients with certain forms of chronic liver disease) Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) can cause life-threatening infection due to the virulence and rapid progression of necrosis and hemorrhage caused by the Panton-Valentine leucocidin toxin
Contributory or predisposing factors

Break in the skin due to trauma, puncture, laceration, animal bite, or sting Burns Skin lesions caused by furuncle, ulcer, or fungal infection (eg, tinea pedis) Surgical procedure or incision, including lymphadenectomy, saphenous vein stripping, and mastectomy Previous cellulitis Diabetes mellitus (type 1 and type 2) Lymphatic stasis Peripheral vascular disease Chronic steroid use Intravenous drug addiction AIDS or other immunodeficiency disorder Liver disease

Renal failure Occupational exposure: farm workers; gardeners; handlers of fish, shellfish, and aquariums

Epidemiology
Incidence and prevalence
Frequency

Common in the U.S., but because it is a non-reportable infection, exact incidence is not known.
Demographics
Age

Facial cellulitis usually occurs in adults aged 50 years or above, or children aged 6 months to 3 years Perianal cellulitis usually affects children
Gender

Perianal cellulitis is more common in male patients than in female patients No gender difference for other types of cellulitis
Geography

Cellulitis caused by halophilic Vibrio species occurs in coastal areas (shellfish handlers).
Socioeconomic status

Immigrant populations who may not have been vaccinated against Haemophilus influenzae type b and tetanus are at increased risk of infection Overcrowded conditions may also exacerbate infection Farm, garden, fish, and shellfish workers are at increased risk of infection by rare agents causing cellulitis
https://www.clinicalkey.com/topics/surgery/cellulitis.html

Definition
Cellulitis is a diffuse, spreading skin infection.

Description
Cellulitis is a skin infection that sometimes accompanies damage to the skin, poor circulation, or diabetes. Streptococcal or staphylococcal bacteria enter the skin through a cut, puncture, ulcer, or sore, producing enzymes that break down the skin cells. Erysipelas is a superficial form of cellulitis. Infants are particularly susceptible to buccal cellulitis, an infection of the skin on the cheek. The infection is characterized by skin discoloration and swelling and is more often misdiagnosed as a bruise. It is caused by any substance that may cause injury to the buccal mucosa, such as popsicles and ice cubes, and prolonged exposure of infants to low temperature. Other infections that are commonly mistaken as buccal cellulitis include erysipelas, severe impetigo, and insect bites. Orbital cellulitis is a rare, acute infection of the eye socket. It affects primarily children, and the onset is rapid and severe. Bacteria enter the orbit of the eye, often from an infection in the sinuses, a boil on the eye or eyelid, or a foreign object. The soft tissue lining becomes infected. In most cases only one eye is affected. This is an acute and dangerous infection and may require hospitalization and antibiotic treatment.

Causes
The lower extremities are the most common site of infection. A skin abnormality (e.g., skin trauma, ulceration, tinea pedis, or dermatitis) often precedes the infection. Scars from saphenous vein removal for cardiac or vascular surgery are common sites for recurrent cellulitis, especially if tinea pedis is present. Frequently, however, no predisposing condition or site of entry is evident. Streptococcus pyogenes is the most common cause of superficial cellulitis with diffuse spread of infection. Staphylococcus aureus occasionally produces a superficial cellulitis typically less extensive that of streptococcal origin and usually only in association with an open wound or cutaneous abscess. Cellulitis occurring after animal bites may be caused by other bacteria, especially Pasteurella multocida from dogs and cats.

Symptoms
In cellulitis, the skin becomes red and swollen and is both warm and painful to the touch and is sometimes accompanied by fever, malaise, chills, and headache. If antibiotics are not given, the condition may progress to abscesses (pockets of pus) and tissue damage. Erysipelas is a superficial form of cellulitis characterized by redness, swelling, vesicles, fever, and pain. It is caused by a species of streptococci, which usually starts with a headache, fever, and general distress, followed by small, redpatches that spread and swell so that the border may be easy to see and feel.

Diagnosis
The diagnosis is usually made by medical history and physical examination alone.

Treatment
In severe cases, antibiotics may be given intravenously for the first 24 to 72 hours, followed by oral antibiotics. Mild cases may only require oral antibiotics. In severe cases that progress rapidly or are associated with necrosis (tissue destruction), necrotizing cellulitisfasciitis is considered. This requires urgent surgical exploration.

Questions
Do the signs and symptoms indicate cellulitis? Is there tissue damage? What is causing the infection? Will you prescribe antibiotics? What are the side effects of the antibiotics? When will the condition clear?

Prevention
Keeping minor abrasions, cuts and bruises clean and free of continued trauma can lessen the likelihood of cellulitis.

http://www.healthcentral.com/encyclopedia/408/667.html

Share This

Cellulitis
Cellulitis is acute bacterial infection of the skin and subcutaneous tissue most often caused by streptococci or staphylococci. Symptoms and signs are pain, rapidly spreading erythema, and edema; fever may occur, and regional lymph nodes may enlarge. Diagnosis is by appearance; cultures are sometimes helpful but awaiting these results should not delay empiric therapy. Treatment is with antibiotics. Prognosis is excellent with timely treatment.

Etiology

Streptococcus pyogenes Staphylococcus aureus

Cellulitis is most often caused by group A -hemolytic streptococci (eg, Streptococcus pyogenes) orStaphylococcus aureus. Streptococci cause diffuse, rapidly spreading infection because enzymes produced by the organism (streptokinase

, DNase, hyaluronidase) break down cellular components that would otherwise contain and localize the inflammation. Staphylococcal cellulitis is typically more localized and usually occurs in open wounds or cutaneous abscesses. Recently, methicillin-resistant S. aureus (MRSA) has become more common in the community (community-associated MRSA [CA-MRSA]). Historically, MRSA was typically confined to patients who were exposed to the organism in a hospital or nursing facility. MRSA infection should now be considered in patients with community-acquired cellulitis, particularly in those with cellulitis that is recurrent or unresponsive to monotherapy. Less common causes are group B streptococci (eg, Streptococcus agalactiae) in older patients with diabetes; gram-negative bacilli (eg, Haemophilus influenzae) in children; and Pseudomonas aeruginosain patients with diabetes or neutropenia, hot tub or spa users, and hospitalized patients. Animal bites may result in cellulitis; Pasteurella multocida is the cause in cat bites, and Capnocytophaga sp is responsible in dog bites. Immersion injuries in fresh water may result in cellulitis caused byAeromonas hydrophila; in warm salt water, by Vibrio vulnificus. Risk factors include skin abnormalities (eg, trauma, ulceration, fungal infection, other skin barrier compromise due to preexisting skin disease), which are common in patients with chronic venous insufficiency or lymphedema. Scars from saphenous vein removal for cardiac or vascular surgery are common sites for recurrent cellulitis, especially if tinea pedis is present. Frequently, no predisposing condition or site of entry is evident.

Symptoms and Signs

Infection is most common in the lower extremities. Cellulitis is typically unilateral; stasis dermatitis closely mimics cellulitis but is usually bilateral. The major findings are local erythema and tenderness, frequently with lymphangitis and regional lymphadenopathy. The skin is hot, red, and edematous, often with surface appearance resembling the skin of an orange (peau d'orange). The borders are usually indistinct, except in erysipelas (a type of cellulitis with sharply demarcated margins see Bacterial Skin Infections: Erysipelas). Petechiae are common; large areas of ecchymosis are rare. Vesicles and bullae may develop and rupture, occasionally with necrosis of the involved skin. Cellulitis may mimic deep venous thrombosis but can often be differentiated by one or more features (see Table 1: Bacterial Skin Infections: Differentiating Cellulitis and Deep Venous Thrombosis ). Fever, chills,

tachycardia, headache, hypotension, and delirium may precede cutaneous findings by several hours, but many patients do not appear ill. Leukocytosis is common.

Table 1
Open table in new window

Differentiating Cellulitis and Deep Venous Thrombosis

Feature Cellulitis Deep Venous Thrombosis
Normal or cool Normal or cyanotic Smooth

Skin temperature Skin color Skin surface

Hot Red Peau d'orange

Lymphangitis and regional lymphadenopathy

Cellulitis

Frequent

Nonexistent

Diagnosis

Examination Blood and sometimes tissue cultures for immunocompromised patients

Diagnosis is by examination. Skin and (when present) wound cultures are generally not indicated because they rarely identify the infecting organism. Blood cultures are useful in immunocompromised patients to detect or rule out bacteremia. Culture of involved tissue may be required in immunocompromised patients if they are not responding to empiric therapy or if blood cultures do not isolate an organism.

Prognosis

Most cellulitis resolves quickly with antibiotic therapy. Local abscesses occasionally form, requiring incision and drainage. Serious but rare complications include severe necrotizing subcutaneous infection (see Bacterial Skin Infections: Necrotizing Subcutaneous Infection ) and bacteremia with metastatic foci of infection. Recurrences in the same area are common, sometimes causing serious damage to the lymphatics, chronic lymphatic obstruction, and lymphedema.

Treatment

Antibiotics Treatment is with antibiotics. For most patients, empiric treatment effective against both group A streptococci and S. aureus is used. Oral therapy is usually adequate with dicloxacillin

250 mg orcephalexin

500 mg qid for mild infections. Levofloxacin

500 mg po once/day or moxifloxacin

400 mg po once/day works well for patients who are unlikely to adhere to multiple daily dosing schedules. For more serious infections, oxacillin

or nafcillin

1 g IV q 6 h is given. Use of initial empiric therapy against MRSA is not typically advised unless there is compelling clinical evidence (eg, contact with a documented case or outbreak; culturedocumented prevalence of > 10% or 15% in a practice area). For penicillin-allergic patients or those with suspected or confirmed MRSA infection, vancomycin

1 g IV q 12 h is the drug of choice (see also Gram-Positive Cocci: Antibiotic resistance). Linezolid

is another option for the treatment of MRSA at a dose of 600 mg IV or po q 12 h for 10 to 14 days. Teicoplanin has a mechanism of action similar to vancomycin

. It is commonly used outside the US to treat MRSA; the usual dose is 6 mg/kg IV q 12 h for 2 doses, followed by 6 mg/kg (or 3 mg/kg) IV or IM once/day. Immobilization and elevation of the affected area help reduce edema; cool, wet dressings relieve local discomfort. Cellulitis in a patient with neutropenia requires empiric antipseudomonal antibiotics (eg, tobramycin

1.5 mg/kg IV q 8 h and piperacillin

3 g IV q 4 h) until blood culture results are available. Penicillin is the drug of choice for cellulitis caused by P. multocida; an aminoglycoside (eg, gentamicin

) is effective against A. hydrophila, and tetracycline

is preferred for V. vulnificus infections. Recurrent leg cellulitis is prevented by treating concomitant tinea pedis, which often eliminates the source of bacteria residing in the inflamed, macerated tissue. If such therapy is unsuccessful or not indicated, recurrent cellulitis can sometimes be prevented by benzathine penicillin 1.2 million units IM monthly or penicillin V or erythromycin

250 mg po qid for 1 wk/mo. If these regimens prove unsuccessful, tissue culture may be required.
Last full review/revision October 2007 by A. Damian Dhar, MD, JD Content last modified February 2012

http://www.merckmanuals.com/professional/dermatologic_disorders/bacterial_skin_infections/cell ulitis.html

Cellulitis
Introduction:

Cellulitis is a bacterial infection of the skin. It can also affect the deeper layers of connective tissue beneath your skin and, in severe cases, spread to your lymph nodes. Bacteria get into the skin through a cut, scrape, or other laceration. Cellulitis most often affects the legs, but it may also affect the arms, face, and scalp. Generally, taking antibiotics cures cellulitis. However, the condition sometimes leads to serious complications. Without treatment, it can become life threatening.
Signs and Symptoms:

Pain and tenderness Edema (swelling caused by fluid in the tissues) Redness of the skin Skin that is warm to the touch Fever Chills

What Causes It?:

Cellulitis is caused by bacteria, most often streptococcus or Staphylococcus aureus, that get into the body through a break in the skin. In 50 - 60% of cases, there is some kind of skin injury (for example, cuts, insect bites, burns, surgical incisions, intravenous catheters, dermatitis). Methicillin-resistant staphylococcus aureua (MRSA) infection is a more serious type of staph infection and is on the rise. In the case of erysipelas, a type of cellulitis involving the lymph system, about one-third of cases are preceded by an upper respiratory infections. It is seen in infants, young children, and the elderly, and is generally caused by streptococcal infection.
Who's Most At Risk?:

You are at risk for developing cellulitis if you have the following:

Older age -- as your circulation grows weaker with age, it' s easier for skin abrasions to become infected Diabetes Chickenpox and shingles Lymphedema (swelling of arms or legs) -- swollen arms and legs may cause skin to crack Fungal infections of the feet -- can also cause cracks in the skin Contaminated wounds A weakened immune system

A general infection

What to Expect at Your Provider's Office:

If you have symptoms of cellulitis, you should see your doctor right away. If you have a fever with a rash, go to the emergency room. Your health care provider will do a thorough physical examination to see what is causing the condition and which antibiotic therapy to prescribe. Blood tests and imaging may also be used.
Treatment Options: Prevention

To help prevent cellulitis, follow these steps: If you have a cut or scrape, wash the area gently with soap and water. Apply an antibiotic cream or ointment, and cover the area with a bandage. Change the bandage every day and watch for signs of infection. If you have diabetes or circulatory problems, check your hands and feet daily for scrapes or cuts, or a fungus such as athlete' s foot. Keep your skin moisturized and don' t go barefoot.
Treatment Plan

Cellulitis is treated with antibiotics. To help ease pain, raise the affected arms or legs, keep still, and apply cool, wet, sterile bandages. If your symptoms aren't better after a few days, you may need hospitalization so doctors can give you antibiotics intravenously (IV).
Drug Therapies

Your health care provider will prescribe antibiotics for your infection as well as pain relievers if needed. Your doctor may prescribe an antibiotic that works against both staph and strep, such as cephalexin (Keflex). It is important to take the entire course of antibiotics, even if your symptoms go away before you finish.
Surgical and Other Procedures

If antibiotics don' t work, you may need surgery to drain any underlying abscess (infected tissue).
Complementary and Alternative Therapies

It is important to get conventional medical treatment for cellulitis. It can spread rapidly, so you should start antibiotics as soon as possible to prevent complications. Most alternative therapies have not yet been studied for use specifically in cellulitis. Some may reduce the risk of

getting cellulitis or ease some of the symptoms when used along with conventional care. You should never treat cellulitis with alternative therapies alone. It is important to tell your doctor if you are taking any herbs or supplements because some may interfere with antibiotic therapy.
Nutrition

The following supplements may strengthen the immune system and help skin heal:

Vitamin C (1,000 mg two to six times per day in adults for short periods) Vitamin E (400 - 800 IU per day) Zinc (30 mg per day) Bromelain (250 mg two to three times per day), taken between meals, reduces inflammation. It is often used with turmeric (Curcuma longa), an anti-inflammatory that makes the effects of bromelain stronger. Bromelain and turmeric can increase the risk of bleeding. If you take blood-thinning medications such as warfarin (Coumadin) or aspirin, do not take bromelain and turmeric without asking your doctor. Probiotic supplement (containing Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) a day, for gastrointestinal and immune health. Taking antibiotics can upset the balance between good and bad bacteria in your gut and cause diarrhea. Taking probiotics, or friendly bacteria, helps restore the right balance.

Researchers have not studied the ways specific nutrients may affect cellulitis. However, flavonoids -- compounds in such fruits as citrus, blueberries, grapes; in vegetables, including onions; and in tea and red wine -- seem to help reduce lymphedema and the risk of cellulitis. Quercetin (up to 1,000 mg two or three times per day) is a flavonoid available as a supplement. Applied to the skin, honey may help wounds heal faster and keep infection at bay. Several studies show that honey, applied as a dressing after surgery, helps incisions heal without complications. Don' t apply honey to an open wound, and talk to your doctor before using honey for any cuts or scrapes.
Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, under the supervision of your health care provider. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or

flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted. There are no scientific studies showing that herbs have a direct effect on cellulitis, but the following herbs may help strengthen the immune system and kill bacteria on the skin. Never apply herbal preparations to an open wound without asking your doctor first. Be sure to tell your doctor about any herbs you use, because some can interfere with conventional treatment. Taken by mouth:

Echinacea (Echinacea spp., 500 - 1,000 mg three times per day) is used to strengthen the immune system. It may also be used topically as a gel or cream containing 15% juice of the herb to treat inflammatory skin conditions. Pycnogenol (Pinus pinaster, 200 mg per day), an extract of the bark of a particular type of pine tree, helps promote skin health. Thyme (Thymus vulgaris, 1 - 2 g per day in divided doses). Thyme may have antibacterial and antifungal properties, although there' s no evidence that it helps treat cellulitis specifically. Thyme can increase the risk of bleeding. Ask your doctor before taking thyme if you take blood-thinning medications such as warfarin (Coumadin) or aspirin, and never take oil of thyme, which can be toxic. Gotu kola (Centella asiatica, 60 mg two times per day). In a few studies, gotu kola seems to help wounds heal and reduce risk of infection. Gotu kola interacts with a number of medications, so be sure to ask your doctor before taking it. Do not take gotu kola if you experience anxiety or have high blood pressure.

Applied to the skin:

Yarrow (Achillea millefolium) is approved in Great Britain for skin infections and inflammation. It is applied topically. Use 100 g per 5 gallons of warm or hot water for a sitz bath. Goldenseal root (Hydrastis canadensis), which has anti-inflammatory and antibacterial properties, and slippery elm (Ulmus fulva), an antiseptic, may be made into a paste and placed on the affected area two times per day. Calendula flower (Calendula officinalis) is approved in Germany for topical application to leg ulcers, open wounds that can readily become infected. Make a tea by adding one to two teaspoons dried flowers to one cup boiling water and steeping for 5 - 10 minutes. Let cool, then soak a sterile, soft cloth with the solution and apply to affected area. Tea tree oil (Melaleuca alternifolia) has antibacterial and antifungal properties. Some studies suggest tea tree oil may help fight athlete' s foot and keep minor cuts and scrapes from becoming infected. Fenugreek seed (Trigonella foenum-graecum), which contains flavonoids, is approved in Germany for external use on skin inflammation and infections. Mix 50 g of powdered fenugreek seed with one quart of hot

water and let stand until it forms a thick paste. Apply to a sterile, soft cloth and place on the affected area.
Homeopathy

Although very few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths would recommend the following remedies for the treatment of cellulitis based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

Apis Mellifica -- for swelling with a puffy appearance that worsens with heat and pressure, especially in the afternoon and is better with cold applications, open air, movement, and sitting upright Cantharis -- for restless and anxious individuals. It may be used for children. Cahtaris is only available under the direction of a licensed homeopath. Lachesis -- for symptoms that tend to be worse on the left side of the body and during and immediately after sleep Mercurius -- for people who are bothered by both heat and cold, and are often trembling and impulsive Rhus toxicodendron -- for people who are restless and anxious with itching that tends to worsen at night but is relieved by warm compresses or pressure Sulphur -- for hot, burning skin with itching that worsens at night and with washing

Seek immediate medical attention if fever and swelling do not subside after 24 hours.
Acupuncture

Acupuncture other Traditional Chinese Medicine practices may help with the underlying cause of cellulitis and may strengthen the immune system. However, no scientific studies have been done to see if they work specifically for cellulitis. The practitioner should be very careful when piercing skin that may be infected, because there is a risk of spreading the infection further. Talk to your doctor first and use a qualified acupuncturist with experience in treating infectious skin disease.
Massage

Do not use massage if you have an active infection. However, massage that promotes lymph drainage, when used with compression and exercise, may help prevent cellulitis.
Prognosis and Possible Complications:

Antibiotics usually cure cellulitis. While complications are rare, they can be serious and even life threatening if the infection spreads to the blood. Complications are more common in very young children, the elderly, or in people who have immune system disorders. Possible complications include abscesses, gangrene (tissue destruction), and thrombophlebitis (inflammation of superficial veins). Some people are prone to recurrence of cellulitis, often in the same area, leading to permanent skin changes. Gangrene may result in loss of a limb.
Following Up:

Your health care provider should see you periodically to make sure you have no complications.
Alternative Names:

Skin infection

Reviewed last on: 6/13/2010 Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

Supporting Research

Belcaro G, Cesarone MR, Errichi BM, et al. Diabetic ulcers: microcirculatory improvement and faster healing with pycnogenol. Clin Appl Thromb Hemost. 2006 Jul;12(3):318-23. Bernard P. Management of common bacterial infections of the skin. Curr Opin Infect Dis. 2008 Apr;21(2):122-8. Betts J. The clinical application of honey in wound care. Nurs Times. 2008 Apr 8-14;104(14):43-4. Biswas TK, Mukherjee B. Plant medicines of Indian origin for wound healing activity: a review. Int J Low Extrem Wounds. 2003 Mar;2(1):25-3 Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. 3rd ed. New York, NY: Penguin Putnam; 1997:320, 331-335, 341, 345. Dursun N, Liman N, Ozyazgan I, et al. Role of thymus oil in burn wound healing. J Burn Care Rehabil. 2003;24:395-9. Keller KL, Fenske NA. Uses of vitamins A, C and E and related compounds in dermatology: a review. J Am Acad Dermatol. 1998;39(4 Pt1):611-625.

Mandell GL, et al. Principles and Practice of Infectious Diseases. 4th ed. New York, NY: Churchill Livingstone; 1995:913-919. Maeda Y, Loughrey A, Earle JA, Millar BC, Rao JR, Kearns A, et al. Antibacterial activity of honey against community-associated methicillinresistant Staphylococcus aureus (CA-MRSA). Complement Ther Clin Pract. 2008 May;14(2):77-82. Mortimer PS. Therapy approaches for lymphedema. Angiology. 1997; 48(1):87-91. Ullman D. Homeopathic Medicine for Children and Infants. New York, NY: Penguin Putnam; 1992: 147, 167-168, 214-216. Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Penguin Putnam; 1995.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. 1997- 2013 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Source: Cellulitis http://www.umm.edu/altmed/articles/cellulitis000033.htm#ixzz2VofJQ3ft University of Maryland Medical Follow us: @UMMC on Twitter | MedCenter on Facebook

Center

http://www.umm.edu/altmed/articles/cellulitis-000033.htm

Cellulitis is a diffuse infection of the skin and subcutaneous tissues characterized by local spreading erythema, warmth, tenderness and swelling. Most infections are mild and are caused by S. aureus or group A streptococci (3). Systemic signs such as fever, chills, and leucocytosis indicate severe cellulitis that usually requires intravenous antibiotic therapy. Patients should be investigated for

underlying diseases including diabetes mellitus and peripheral arterial occlusive disease that worsen the prognosis. Infections at some sites are regarded as high risk cellulitis because they are prone to serious complications. These include facial and orbital cellulitis (4), post adenectomy and postvenectomy cellulitis of the extremities, and infected animal and human bites of the hands. Facial cellulitis that originates in the teeth or gums is odontogenic. It occurs typically in the lower face of older children. Most facial cellulitis is non-odontogenic and occurs in the upper face of infants and younger children. Typical examples are erysipelas and Haemophilus influenzae type B (HIB) cellulitis. The peau d'orange cellulitis of erysipelas follows streptococcal upper respiratory infection that invades the dermis and lymphatics of the cheek. Similar infection by Haemophilus influenzae type B results in the characteristic bruised cheek appearance of HIB cellulitis now uncommon with the use of H. influenzee vaccine (5). Postadenectomy and postvenectomy cellulitis are caused by lymphedema that is secondarily infected by non-group A streptococci. High risk hand infections include erysipeloid and infected human and animal bites. Erysipeloid is diagnosed when a spreading violaceous wound appears at the site of a minor wound on the hand of a worker handling fish, meat, or poultry. The infection is caused by the gram positive bacillus Erysipelothrix rhusiopathae. Animal and human bites are dangerous when secondary infection occurs and tenosynovitis develops in deep tendons. Pasteurella multocida in cat bites, and Eikenella corrodens in human bites are common pathogens. Delay in seeking treatment and anaerobic conditions in deep hand infections favor tissue necrosis and rapid progression (6). The spread of infection in cellulitis is associated with toxins and enzymes produced by the offending organisms. Further, a disparity has been noted between the low frequency of positive culture of deep aspirates of these wounds and the marked inflammation observed. This has recently been attributed to cytokines such as interleukin-1 and tumor necrosis factor produced by specific dendritic cells of Langerhans in the stratum spinosum of the skin when they are exposed to bacterial components. The inflammatory response may therefore persist even when the bacteria have been killed by antibiotics.

http://www.ncbi.nlm.nih.gov/books/NBK6971/