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Classification and external resources

Infected left shin

ICD-10 L03.
ICD-9 682.9
DiseasesDB 29806
eMedicine med/310 emerg/88 derm/464
MeSH D002481

Cellulitis is a diffuse inflammation[1] of connective tissue with severe inflammation of dermal

and subcutaneous layers of the skin. Cellulitis can be caused by normal skin flora or by
exogenous bacteria, and often occurs where the skin has previously been broken: cracks in the
skin, cuts, blisters, burns, insect bites, surgical wounds, or sites of intravenous catheter insertion.
Skin on the face or lower legs is most commonly affected by this infection, though cellulitis can
occur on any part of the body. The mainstay of therapy remains treatment with appropriate
antibiotics, and recovery periods can be anything from 48 hours to six months.

Erysipelas is the term used for a more superficial infection of the dermis and upper subcutaneous
layer that presents clinically with a well defined edge. Erysipelas and cellulitis often coexist, so it
is often difficult to make a distinction between the two.
Cellulitis is unrelated (except etymologically) to cellulite, a cosmetic condition featuring
dimpling of the skin. It also has nothing in common with gingivitis.


• 1 Signs and symptoms

• 2 Causes
o 2.1 Risk factors
• 3 Diagnosis
• 4 Treatment
• 5 In animals
• 6 See also
• 7 References

• 8 External links

[edit] Signs and symptoms

Infected left shin in comparison to shin with no sign of symptoms

The typical symptoms of cellulitis is an area which is red, hot, and tender.

[edit] Causes
Cellulitis is caused by a type of bacteria entering the skin, usually by way of a cut, abrasion, or
break in the skin. This break does not need to be visible. Group A Streptococcus and
Staphylococcus are the most common of these bacteria, which are part of the normal flora of the
skin but cause no actual infection while on the skin's outer surface.

Predisposing conditions for cellulitis include insect bites, blistering, animal bite, tattoos, pruritic
skin rash, recent surgery, athlete's foot, dry skin, eczema, injecting drugs (especially
subcutaneous or intramuscular injection or where an attempted IV injection "misses" or blows
the vein), pregnancy, diabetes and obesity, which can affect circulation, as well as burns and
boils, though there is debate as to whether minor foot lesions contribute.

Occurrences of cellulitis may also be associated with the rare condition Hidradenitis

The photos shown here of Cellulitis are of mild cases and are not representative of earlier stages
of the disease. Usually the itch and/or rash appears a little after it vanishes leaving only a small
mark which is commonly ignored.

The appearance of the skin will assist a doctor in determining a diagnosis. A doctor may also
suggest blood tests, a wound culture or other tests to help rule out a blood clot deep in the veins
of the legs. Cellulitis in the lower leg is characterized by signs and symptoms that may be similar
to those of a clot occurring deep in the veins, such as warmth, pain and swelling (inflammation).

This reddened skin or rash may signal a deeper, more serious infection of the inner layers of
skin. Once below the skin, the bacteria can spread rapidly, entering the lymph nodes and the
bloodstream and spreading throughout the body.This can result in flu like symptoms with a high
temperature and sweating or feeling very cold with shaking as the sufferer cannot get warm.

In rare cases, the infection can spread to the deep layer of tissue called the fascial lining.
Necrotizing fasciitis, also called by the media "flesh-eating bacteria," is an example of a deep-
layer infection. It represents an extreme medical emergency.

[edit] Risk factors

The elderly and those with immunodeficiency (a weakened immune system) are especially
vulnerable to contracting cellulitis. Diabetics are more susceptible to cellulitis than the general
population because of impairment of the immune system; they are especially prone to cellulitis in
the feet because the disease causes impairment of blood circulation in the legs leading to diabetic
foot/foot ulcers. Poor control of blood glucose levels allows bacteria to grow more rapidly in the
affected tissue and facilitates rapid progression if the infection enters the bloodstream. Neural
degeneration in diabetes means these ulcers may not be painful and thus often become infected.

Immunosuppressive drugs, and other illnesses or infections that weaken the immune system are
also factors that make infection more likely. Chickenpox and shingles often result in blisters that
break open, providing a gap in the skin through which bacteria can enter. Lymphedema, which
causes swelling on the arms and/or legs, can also put an individual at risk.

Diseases that affect blood circulation in the legs and feet, such as chronic venous insufficiency
and varicose veins, are also risk factors for cellulitis.

Cellulitis is also extremely prevalent among dense populations sharing hygiene facilities and
common living quarters, such as military installations, college dormitories, nursing homes and
homeless shelters.
[edit] Diagnosis
Cellulitis is most often a clinical diagnosis, and local cultures do not always identify the
causative organism. Blood cultures usually are positive only if the patient develops generalized
sepsis. Conditions that may resemble cellulitis include deep vein thrombosis, which can be
diagnosed with a compression leg ultrasound, and stasis dermatitis, which is inflammation of the
skin from poor blood flow. Associated musculoskeletal findings are sometimes reported. When it
occurs with acne conglobata, hidradenitis suppurativa, and pilonidal cysts, the syndrome is
referred to as the follicular occlusion triad or tetrad.[2]

There have been many cases where Lyme disease has been misdiagnosed as staph- or strep-
induced cellulitis. Because the characteristic bullseye rash does not always appear in patients
infected with Lyme disease, the similar set of symptoms may be misdiagnosed as cellulitis.
Standard treatments for cellulitis are not sufficient for curing Lyme disease. The only way to rule
out Lyme disease is with a blood test, which is recommended during warm months in areas
where the disease is endemic.[3]

[edit] Treatment
Treatment consists of resting the affected area, cutting away dead tissue, and antibiotics (either
oral or intravenous).[4] Flucloxacillin or Dicloxacillin monotherapy (to cover staphylococcal
infection) is often sufficient in mild cellulitis, but in more moderate cases, or where streptococcal
infection is suspected, then this course is usually combined with oral phenoxymethylpenicillin or
intravenous benzylpenicillin, or ampicillin/amoxicillin (e.g. co-amoxiclav in the UK). Pain relief
is also often prescribed, but excessive pain should always be investigated as it is a symptom of
necrotising fasciitis, which requires emergency surgical attention.

As in other maladies characterized by wounds or tissue destruction, hyperbaric oxygen treatment

can be a valuable adjunctive therapy, but is not widely available.[5][6]