Cellulitis is a bacterial skin infection of the dermis and subcutaneous fat, most commonly caused by Staphylococcus or Streptococcus bacteria. It has an incidence rate of 24.6 per 1,000 person-years and most often affects the lower extremities. Risk factors include local skin trauma, pre-existing skin infections, and immunosuppression. Mild cases are treated with oral antibiotics while more severe cases require intravenous antibiotics and hospitalization. Complications can include blood infections, bone infections, and in rare cases, tissue death.

1. PRESENTED BY,
Mrs. Rijo Lijo.
Lecturer.
CELLULITIS

2. DEFINITION
Cellulitis is a bacterial infection involving the
inner layers of the skin. It specifically affects the dermis
and subcutaneous fat.

3. INCIDENCE
The cellulitis incidence rate of 24.6/1000 person-
years, with a higher incidence among males and individu
als aged 45-64 years. The most common site of infection
was the lower extremity (39.9%).

4. ETIOLOGY
 Staphylococcus.
 Streptococcus Group A β.
 H. Influenza (periorbital cellulitis).
 Facial cellulitis in children < 3 years old.
 Streptococcus pneumonia.

5. RISK FACTORS
 Local trauma (e.g., lacerations, insect bites, wounds).
 Skin infections such as impetigo, scabies etc.
 Underlying skin ulcer.
 Fragile skin.
 Immunocompromised host.
 Diabetes mellitus.
 Inflammation (e.g., eczema).
 Edema secondary to venous insufficiency or lymphe
dema.

6. PATHOPHYSIOLOGY

7. CLINICAL MANIFESTATIONS
 pain and tenderness in the affected area.
 redness or inflammation of your skin.
 a skin sore or rash that grows quickly.
 tight, glossy, swollen skin.
 a feeling of warmth in the affected area.
 an abscess with pus.
 fever.

8. DIAGNOSTIC FINDINGS
 History collection.
 Physical examination.
 culture and sensitivity:
Swab any wound discharge for culture and sensitivity.

9. Blood culture If:
1. Systemic toxicity (fever, chills, tachycardia).
2. Extensive skin or soft tissue involvement.
3. Underlying comorbidities (lymphedema, malignancy,
neutropenia, immunodeficiency, splenectomy, diabetes).
4. Special exposures (animal bite).
5. Persistent cellulitis.

10.  Radiographic examination:
US (skin abscess), MRI (osteomyelitis), CT (necrotizing
faciatious).
 A skin biopsy if the diagnosis is uncertain.
 Cultures of swabs from intact skin are not helpful.

11. MANAGEMENT AND
INTERVENTIONS

12. GOALS OF TREATMENT FOR
MILD CELLULITIS
Goals of Treatment for Mild Cellulitis
 Resolve infection.
 Identify formation of abscess.
 Check tetanus prophylaxis.

13. MEDICAL MANAGEMENT
 Mild cases of cellulitis can be treated on an outpatient
basis with oral antibiotic therapy with Dicloxacillin, Amo
xicillin, or Cephalexin.
 If the cellulitis is severe, the patient is hospitalized and
treated with intravenous antibiotics for at least 7 to 14 d
ays.
 Immobilize the part and elevate the extremity above the
level of heart.
 Provide moist heat to promote wound healing.

14.  Patients with known community acquired MRSA or pu
rulent cellulitis:
trimethoprim-sulfamethoxazole 8-12 mg / kg per
day for 7 days (dosing is based on trimethoprim).

15. NON PHARMACOLGICAL
MANAGEMENT
 Apply warm or, if more comfortable, cool saline
compresses to affected areas for 15 minutes.
 Mark border of erythema with pen to monitor spread.
 Elevate, rest and gently splint the affected limb.

16. COMPLICATIONS
 Blood infection (septicemia).
 Bone infection (osteomyelitis).
 Inflammation of the lymph vessels (lymphangitis).
 Inflammation of the heart (endocarditis).
 Meningitis.
 Shock.
 Tissue death (gangrene).