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 By
Adam Brochert, M.D.
PersonalMD.com
Medical Contributor
 Acute
cellulitis is the medical term for an infection of the skin and
subcutaneous (underneath the skin) tissues. The involved area usually
becomes swollen, red and painful. There may be pus or clear drainage
from the area of skin break down. It is also not uncommon to have
fever and chills along with the local symptoms.
The
treatment for cellulitis is fairly straightforward. If the infection
is mild, many patients can be treated at home with oral antibiotics.
Local application of moist heat, rest and elevation if the cellulitis
involves an arm or leg are often helpful adjuncts to antibiotics.
Patients may also be given a tetanus vaccine booster shot, especially
in the setting of a puncture wound.
With
more severe infections, patients are admitted to the hospital to
receive intravenous antibiotics for several days. Certain patients
are more prone to developing severe infections due to other medical
problems. The most commonly affected group is diabetics.
Diabetics
are prone to infections of the feet for a few reasons. First, many
diabetics have decreased sensation in their feet. When trauma to
the foot occurs, it may go unnoticed because of the loss of sensation.
Because patients arent aware that an injury has occurred, they
may fail to clean the area and/or may continue to bear weight on
the injured foot. This usually means the infection will be worse
by the time it is noticed.
Second,
many diabetics have poor circulation in their feet. Because of this,
white blood cells cannot reach the infection. Lastly, due to higher
blood sugar levels, white blood cells do not function as effectively
even when they can reach the affected area. For all these reasons,
diabetes is the number one reason for limb amputation in the United
States. These amputations are usually done because of infections.
Diabetics
are advised to wear loose, comfortable shoes and inspect their feet
regularly for sores, ingrown toenails and blisters. With meticulous
hygiene, many diabetics can avoid foot infections. If trauma occurs,
especially in the setting of decreased sensation, diabetics should
have their affected foot/leg examined by a health professional to
rule out an injury. X-rays may be taken even in the absence of pain
to rule out fractures.
For
the non-diabetic, certain precautions can help reduce the risk of
cellulitis after trauma. First, thoroughly wash any traumatized
area of skin and keep it clean until it has healed over. Second,
be sure to get a tetanus vaccine booster shot if it has been more
than five or ten years since your last one, especially in the setting
of a puncture wound (e.g. stepping on a rusty nail). Third, always
go see a doctor after any type of bite (human or animal) which causes
a break in the skin. These types of injuries are often treated prophylactically
with antibiotics to prevent infection.
For
the international traveler, it is important to remember the possibility
of rabies after a bite by a dog or wild animal. In the U.S., rabies
is rare due to mandatory vaccination of cats and dogs, and cases
generally come from wild animal bites (raccoons, bats, skunks, and
foxes). In some other countries, however, rabies is still prevalent
in cats and dogs. Anyone who is bitten by an animal while traveling
abroad is advised to seek medical attention immediately.
Cellulitis
is a fairly common infection that occurs after a break in the skin,
which may or may not be noticeable. Early treatment with antibiotics
can cure most symptomatic cases, however diabetics and those
who sustain puncture wounds or bites should seek medical attention
even in the absence of suggestive symptoms. And, as your mother
probably taught you, dont forget to wash the affected area well!
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