The skin you see is made up of layers: the upper layer which is the epidermis, underneath it is the dermis and the deepest layer is the subcutaneous tissue. Imagine the skin is like a smores: the epidermis is the graham cracker, the dermis is the Hershey’s chocolate bar and the subcutaneous tissue is the marshmallow. In cellulitis, it is the chocolate bar and the marshmallows that are involved or infected, i. e. the dermis and the subcutaneous tissue. It typically occurs in areas where a break in the integrity of the skin occurred such as after an abrasion, a scratch, an insect bite or a punctured wound. It may also result from blood-borne spread of infection to the skin and subcutaneous tissue; think a U-haul truck carrying your stuff from your house to a new one.
It is most commonly caused by beta-hemolytic streptococci (the same organism that causes strep throat), Staphylococcus aureus (the culprit bacteria that can make your pimple look like an about-to-erupt volcano) and Haemophilus influenza type B (the organism that can cause meningitis and pneumonia in kids less than three years of age). Cellulitis can occur at any age and involve any site but the extremities are most often noted.
How do you know if you have cellulitis? Stop, look and feel.
? Stop – and take time to examine the area involved.
? Look – is there swelling and redness? Does the area/lesion have ill-defined borders (in contrast to erysipelas, cellulitis has ill-defined borders since the inflammatory process occurs deep in the skin)?
? Feel – is it warm to touch? Is it tender? Is there pitting upon pressure? If the answer to all the above is a resounding yes? Then it is cellulitis.
So you’ve determined its cellulitis (and it’s not a hot dog), how do you treat it? We give it a whole lot of tender, loving care via antibiotics, primarily cephalexin and clindamycin with analgesics and anti-inflammatory agents (acetaminophen, NSAIDS). In cases where the cellulitis involves the buccal and peri-orbital areas (i. e. around the mouth and eyes) without a clear cut focus, then the heavy weights come in, the third generation cephalosporins: cefotaxime, ceftriaxone plus clindamycin.
So the next time you see something on your body that is red, warm, and tender: STOP, LOOK and FEEL it might be cellulitis.