Cellulitis is a common deep skin infection that primarily affects the subcutaneous tissue and lymphatic system. This condition is usually caused by bacteria invading skin injuries or natural barrier defects, with common symptoms including redness, swelling, heat, and pain; in severe cases, it may lead to systemic infections. Timely diagnosis and treatment are crucial to prevent complications.
The key to cellulitis lies in the interaction between bacterial infection and the host's immune status. Staphylococcus aureus and Group A Streptococcus are the most common pathogens. Patients may have an increased risk of infection due to trauma, surgical wounds, or chronic skin lesions. Modern medicine has developed various treatment options, including antibiotic therapy and surgical intervention, but preventive measures remain an important aspect of controlling this disease.
The core of cellulitis development is the invasion of bacteria into the deep structures of the skin. When the skin barrier is compromised due to cuts, abrasions, or insect bites, bacteria may take advantage of the situation. Staphylococcus aureus and Group A Streptococcus are the primary pathogens, and the toxins they release can cause tissue edema and inflammatory responses. In special cases, fungal or atypical bacterial infections may also trigger similar symptoms, but these are relatively rare.
Immunocompromised individuals are significantly at higher risk for infection. Diabetic patients, due to poor peripheral circulation and nerve damage, have a foot infection risk that is three times higher than that of the general population. Patients receiving steroid treatment or using immunosuppressants after organ transplants may experience a faster deterioration of their condition after infection. Chronic skin diseases such as eczema or rosacea may also compromise the skin barrier, becoming a pathway for bacterial invasion.
Initial symptoms usually appear near the wound, including local redness, swelling, and increased temperature. The skin in the infected area may exhibit an orange peel appearance, and there may be a palpable firmness upon examination. The level of pain varies depending on the depth of the infection; some patients may experience throbbing pain or tenderness. When the infection involves lymphatic vessels, it may be accompanied by lymphadenopathy and fever.
Severe cases may present systemic symptoms such as fever, chills, and palpitations. Approximately 15% of patients may exhibit purulent symptoms, forming abscesses or tissue necrosis. If the infection spreads to the bloodstream, it may lead to sepsis, resulting in a drop in blood pressure and organ failure, posing life threats. Pediatric patients may show more subtle symptoms due to an underdeveloped immune system.
Physicians first conduct a detailed skin examination, observing the extent of redness and temperature changes. Palpation may reveal tissue induration and tenderness. If deep infection is suspected, ultrasound or computed tomography may be arranged. Blood tests can measure white blood cell counts, and elevated C-reactive protein often indicates the presence of inflammation.
Differential diagnosis must exclude other skin infections, distinguishing cellulitis from erysipelas, which typically has more defined borders of erythema. If symptoms are atypical, a tissue biopsy may be necessary. For suspected sepsis patients, blood cultures should be performed immediately to identify the pathogen.
Blood cultures can confirm the type of bacteria, but culture results usually take 48 hours. Elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) help assess the severity of the infection. Ultrasound can detect fluid accumulation or abscess formation in deep tissues, while computed tomography has high accuracy in assessing bone involvement.
First-line treatment typically involves oral antibiotics, such as penicillins or cephalosporins. In cases suspected of having resistant strains (such as MRSA), vancomycin or daptomycin may be used instead. The treatment course usually lasts 10-14 days, and it is essential to complete the entire course to avoid relapse.
Severe cases require hospitalization for intravenous antibiotic therapy, along with pain management and adjustments to fluid and electrolyte balance. Special populations, such as diabetic patients, may require longer treatment courses and regular monitoring of blood glucose control. During the treatment period, patients should avoid self-discontinuing medication, even if symptoms improve; the full course must be completed.
Local care includes wound debridement and cleaning, using sterile dressings to prevent secondary infections. Elevating the affected limb can reduce swelling, and ice packs can alleviate acute pain. Patients with severe edema may require compression garments or elastic bandages to assist with swelling reduction.
Skin care is a key measure in preventing infections. Daily checks of damaged skin areas and the use of antibacterial ointments to protect minor wounds are recommended. Diabetic patients should pay special attention to foot care, regularly trimming nails and avoiding walking barefoot.
Cancer patients undergoing chemotherapy should wear protective gloves to minimize exposure to chemicals. Patients with lymphedema should follow pressure therapy protocols to avoid limb injuries. Immunocompromised patients may receive prophylactic antibiotics before invasive procedures.
Seek medical attention immediately when experiencing unexplained redness that continues to expand. If fever exceeds 38.5°C and persists for more than 24 hours, or if the level of pain affects daily activities, urgent diagnosis should be arranged. Immediate medical attention is required in the following situations:
For diabetic patients or those with immunodeficiency, even mild symptoms should prompt early medical consultation. Delaying treatment may lead to serious complications such as osteomyelitis or sepsis, increasing the risk of amputation or organ failure.
If the infection worsens, patients may experience persistent high fever, severe local redness and swelling, increased pain, and possibly chills or altered consciousness. If these symptoms occur, immediate medical attention is necessary, as they may indicate the onset of sepsis or deep tissue necrosis.
Which chronic diseases increase the risk of bacterial skin cellulitis?Patients with diabetes, lymphatic system damage (such as after surgery or radiation therapy), peripheral vascular disease, or immunocompromised conditions (such as AIDS or long-term steroid use) have a higher risk of infection due to impaired skin repair capabilities and should pay special attention to skin wound care.
Is it safe to use natural ointments or herbal treatments?It is not recommended to rely solely on natural ointments or herbal treatments, as bacterial cellulitis requires antibiotics to effectively eradicate the pathogens. Misusing unverified home remedies may delay treatment and lead to the spread of infection; patients should adhere to prescribed medications.
What serious complications may arise if bacterial cellulitis is not treated in a timely manner?In severe cases, it may lead to sepsis, deep tissue necrosis, or osteomyelitis, potentially threatening life. If the infection spreads to the bloodstream or bones, the complexity and risks of treatment will significantly increase, making early diagnosis crucial.
How can individuals who have previously suffered from bacterial cellulitis prevent recurrence?Individuals who have had cellulitis should enhance skin care, avoid injuries or cuts, and regularly monitor chronic diseases (such as diabetes). If there is any skin damage, it should be cleaned immediately and treated with antibiotic ointment, while monitoring for signs of redness and swelling, seeking medical attention promptly if necessary.
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