SEMINAR ON CELLULITIS

◦ BY
◦ S.JYOTHSNA
◦ 170518882013
◦ SVCP
INTRODUCTION
:
◦ Cellulitis is a common infection of the skin and the soft tissues underneath. It
happens when bacteria enter a break in the skin and spread.
◦ The affected skin appears swollen and red and is typically painful and
w a r m to the touch.
◦ Cellulitis usually affects the skin on the lower legs, but it can occur in the
face, arms and other areas. It occurs when a crack or break in your skin
allows bacteria to enter.
◦ If Left untreated, the infection can spread to your lymph nodes and
bloodstream and rapidly become life-threatening. It isn't usually spread
from person to person.
CAUSES:
◦Cellulitis occurs when bacteria, most commonly streptococcus and
staphylococcus, enter through a crack or break in the skin. The incidence of a
more serious staphylococcus infection called methicillin-resistant
Staphylococcus aureus (MRSA) is increasing.
◦Although cellulitis can occur anywhere on the body, the most common location
is the lower leg. Bacteria are most likely t o enter disrupted areas of skin, such
as where there is a recent surgery, cuts, puncture wounds, an ulcer, athlete's
foot or dermatitis.
◦A n i m a l bites can cause cellulitis. Bacteria can also enter through areas of d r y,
flaky skin or swollen skin.
◦Cellulitis most commonly results f r o m infection w i t h group A
b e t a - hemolytic streptococcus (i.e., Streptococcus pyogenes).
RISK FACTORS:
• 1.Injury. A n y cut, fracture, burn or scrape gives bacteria an entry point.
• 2.Weakened immune system. Conditions t h a t weaken our i mmu n e system — such as diabetes,
leukemia and tfIV/AIDS — leave more susceptible to infections. Certain medications also can
weaken our i mmu n e system.
• 3.Skin conditions. Conditions such as eczema, athlete's foot and shingles can cause breaks in the
skin, which give bacteria an entry point.
• 4.Chronic swelling of your arms or legs (lymphedema). This condition sometimes follows surgery.
• 5.History of cellulitis. tfaving had cellulitis before makes you prone to develop i t again.
• 6.Obesity. Being overweight or obese increases your risk of developing cellulitis.
• Patients w i t h comorbidities such as diabetes mellitus, venous insufficiency,
peripheral arterial disease, and lymphedema are a t higher risk of developing
cellulitis .
PATHOPHYSIOLOGY:

◦Cellulitis is characterized by erythema, w a r m t h , edema, and tenderness to

palpation resulting f r o m cytokine and neutrophil response f r o m bacteria breaching
the epidermis. The cytokines and neutrophils are recruited to the affected area after
bacteria have penetrated the skin leading to an epidermal response. This response
includes the production of antimicrobial peptides and keratinocyte proliferation
and is postulated to produce the characteristic exam findings in cellulitis. Group A
Streptococci, the most common bacteria to cause cellulitis, can also produce
virulence factors such as pyrogenic exotoxins (A, B, C, and F) and streptococcal
superantigen t h a t can lead to a more pronounced and invasive disease.
◦ Symptoms :
◦ Possible signs and symptoms of cellulitis, which usually occur on one side of the
body, include:
• Red area of skin t h a t tends to expand
• Swelling
• Tenderness
• Pain
• Wa r m t h
• Fever
• Red spots
• Blisters
• Skin dimpling
EVALUATION:
◦ Cellulitis is diagnosed clinically based on the presence of spreading erythematous i n f l a m ma t i o n
of the deep dermis and subcutaneous tissue. I t characteristically presents w i t h worsening
erythema, edema, w a r m t h , and tenderness.

◦ Two of the four criteria ( w a r m t h , erythema, edema, o r tenderness) are required t o make
the diagnosis. Its most c o m m o n presentation is on the lower extremities but can affect any
area of the body. I t is most often unilateral and rarely (if ever) presents bilaterally.
◦ The patient's skin should be thoroughly evaluated t o f i n d the potential source f o r the cellulitis
by looking f o r microabrasions of the skin secondary t o injuries, insect bites, pressure ulcers, o r
injection sites.

◦ Blood cultures are also necessary when a patient has signs of systemic infection .
TREATMENT:
◦ The duration of oral antibiotic therapy should be f or a m i n i m u m duration of 5
days. The best antibiotic to t reat cellulitis include dicloxacillin, cephalexin,
trimethoprim with sulfamethoxazole, clindamycin, or doxycycline antibiotics.
◦ In non purulent cellulitis, patients should receive cephalexin 5 0 0 m g every 6 hours.
If they have a severe allergic reaction to beta-lactamase inhibitors, t reat w i t h
clindamycin 3 0 0 m g to 4 5 0 m g every 6 hours.
◦ In patients w i t h purulent cellulitis, methicillin-resistant staph aureus colonization,
cellulitis associated w i t h an abscess or extensive puncture wounds, patients should
receive antibiotics t h a t cover against methicillin-resistant staph aureus as well.
◦ Cellulitis w i t h MRSA risk factors should be treated w i t h t r i m e t h o p r i m -
sulfamethoxazole 8 0 0 m g / 1 6 0 m g twice daily f or 5 days in addition to cephalexin
5 0 0 m g every 6 hours.
◦ If a patient has an allergy to trimethoprim-sulfamethoxazole, t reat w i t h
clindamycin 3 0 0 m g to 4 5 0 m g every 6 hours. A longer duration of antibiotic
t r e a t m e n t m a y be a consideration in patients who show m i n i m a l improvement
w i t h antibiotic therapy w i t h i n 4 8 hours.
◦ In immunocompromis ed patients requiring hospitalization f o r parenteral antibiotics, b r o a d -
spectrum antimicrobial coverage m a y be necessary w i t h vancomycin plus piperacillin-
tazobactam o r a carbapenem.

◦ PREVENTION :
• Wash your wound daily with soap and water. Do this gently as p a r t of your n o r m a l bathing.
• Apply a protective cream or ointment. For most surface wounds, an o v e r - t h e - c o u n t e r
o i n t m e n t (Vaseline, Polysporin, others) provides adequate protection.
• Cover your wound with a bandage. Change bandages a t least daily.
• Watch for signs of infection. Redness, pain and drainage all signal possible infection and the
need f o r medical evaluation.
◦ LIFE STYLE AND HOME REMEDIES :
◦ steps to help ease any pain and swelling:
• Place a cool, d a m p cloth on the affected area as often as needed f or your comfort.
• Ask the doctor to suggest an over-the-counter pain medication to t reat pain.
• Elevate the affected p a r t of your body.
• Ask the doctor whether i t m i g h t help to wear compression wraps or stockings.
◦TtfANK
YOU