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What is Cellulitis ?


Cellulitis is a diffuse inflammation of the dermal and subcutaneous layers of the skin caused by haemolytic streptococcus.

Pathology

Cellulitis occurs when the dermal and subcutaneous layers of the skin get infected by hemolytic streptococcus.
The streptococci infect and colonize the subcutaneous layer of the skin.
These streptococci produce lytic enzymes like hyaluronidase and streptokinase which breakdown the connective tissue in the subcutaneous layer of the skin.
This leads to quick and diffuse spread of the inflammation over a large area.
In case of cellulitis affecting areas of the body with loose skin and subcutaneous tissue like in the face, forearm or scrotum, the inflammation spreads fast.
Exudation occurs as a result of this inflammation.
This exudate spreads in the subcutaneous and facial layers resulting in gross swelling of the affected part.

Etiology

Cellulitis occurs when streptococci infect wounds in the skin.
This can occur in cases of injuries on the skin.
Injuries, minor or major provide the streptococci access to the subcutaneous tissue.
Injuries in the form of graze or scratch injuries, snake bites, scorpion stings, etc. predispose to cellulitis.

Presence of certain preexisting conditions influences the intensity and the rate of spread of cellulitis.
Conditions like diabetes, AIDS, immuno-compromised individuals, people on chemotherapy etc lead rapid spread and intense inflammation in cellulitis.

Common sites of occurrence for cellulitis are the face, scrotum and the lower limbs.

 Clinical features

  • Characteristic signs of inflammation like redness, itching, localized increase in temperature of the skin and diffuse swelling without a distinct margin are seen on the affected part. Pain starts later.
  • If treatment is not started at this stage, systemic manifestations like fever and toxemia develop due to the presence of the infection in the body.
  • In cases left untreated, suppuration, sloughing of the overlying skin and gangrene can occur as the cell death progresses at the site of occurrence.


Treatment

  • Bed rest and elevation – the patient is advised total bed rest and the affected part is elevated as this causes a reduction in the edema present.
  • Dressing of the affected area - Glycerin MgSO4 dressing is done. This reduces the edema of the affected part by osmotic effect.
  • Management of pre-existing conditions – Preexisting conditions like diabetes if present should be appropriately managed with injections of insulin given subcutaneously.
  • Antibiotics – The patient is put on antibiotics to combat the infection. Injections of crystalline penicillin given intra muscularly or intravenously for 5-7 days or cephalosporins are used.
  • In case of cellulitis occurring due to snake bite, anti snake venom (ASV) is given to the patient.


Complications

  • Abscess – Cellulitis can worsen and turn into an abscess. This will require draining of the abscess before any further treatment is instated.
  • Necrotizing fasciitis – Infection due to certain highly invasive bacteria like the Streptococcus pyogens can lead to extensive necrosis of the skin and subcutaneous tissue. This is known as Necrotizing fasciitis. This is managed by surgical debridement followed by skin grafting at a later date.
  • Septicemia and toxemia – In case of an extensive Streptococcal infection, the patient may go into Toxic shock syndrome. This occurs due to the exotoxins produced by the bacteria, being released into the blood.
  • In a patient suffering from Diabetes Mellitus, cellulitis may precipitate ketoacidosis.

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