As a wound care professional, it’s likely you frequently encounter patients with cellulitis. A solid understanding of cellulitis wounds will give you the knowledge necessary to help you properly care for this population of patients.

What is cellulitis?

According to The National Library of Medicine, cellulitis is a common skin infection caused by bacteria. It normally affects the dermal skin layer but may extend beyond the dermal layer to the hypodermis or subcutaneous level.

Our skin is the largest organ of our bodies and protects us from bacteria. Bacteria live on our skin but are not normally able to penetrate this protective barrier. If the skin is broken, bacteria have a route to the inner layers where an infection may begin. These breaks in the skin may be caused by dry, cracked, or peeling skin. They may also be caused by an injury, recent surgery, animal bites or scratches, and ulcers from chronic conditions such as diabetes or lymphedema.

Although cellulitis can develop on any part of the body, the most common areas are the legs, feet, hands, and arms. Staphylococcus and Streptococcus are the most common organisms to cause a cellulitis infection.

Cellulitis frequently occurs where there is increased swelling and decreased blood flow, such as the lower legs of a patient with lymphedema, diabetes, or peripheral vascular disease. Cracks in the feet can lead to fungal infections in addition to bacterial infections. Although less common, it is possible for an otherwise healthy person with no obvious skin damage or open areas to develop cellulitis wounds.

What are some symptoms of cellulitis?

Common symptoms of cellulitis are:

  • Redness
  • Pain
  • Warmth
  • Tenderness
  • Swelling
  • Blisters
  • Chills
  • Fever
  • Streaking

Cellulitis of the arms and legs normally affects only one extremity. Although it certainly is possible for both extremities to be affected at the same time, bilateral lower leg redness is more likely due to stasis dermatitis.

This fact may make it easier to differentiate between lower leg cellulitis versus stasis dermatitis when lower extremity redness is present. A thorough visual exam and understanding of the patient’s history is important for medical providers to differentiate between these two diagnoses.

Cellulitis treatment and prevention measures

Cellulitis is diagnosed by a visual physical exam and thorough history gathering. Treatment normally begins with an oral antibiotic. If the infection does not seem to be responding to oral treatment, medication changes or hospital admission for intravenous antibiotic administration may be necessary.

An inpatient stay may also be necessary if the cellulitis is advanced, covers a large area of the body, or there are signs of bacteremia and sepsis such as fever, chills, nausea, and vomiting.

To reduce the risk of developing recurrent cellulitis, there are a few things patients and providers should keep in mind:

  1. Patients should be taught to protect their skin from injury by taking care to prevent cuts, scrapes, burns, bites, and stings.
  2. Teach patients to immediately cleanse any new breaks in the skin with a mild soap and water. Cover any open areas with a bandage to protect against bacteria and change the bandage as necessary to keep it clean and dry.
  3. Teach patients to keep their skin clean and moisturized. This is an important prevention measure. Cracks in the skin allow bacteria to enter the deeper layers. Keeping the skin moisturized will prevent excessive dryness which can lead to scratching and cracking.
  4. Teach patients to keep their fingernails and toenails clean and short. This will reduce the amount of bacteria introduced into the skin when scratching. Nail care for diabetics is especially important.
  5. Instruct patients on the importance of maintaining a healthy weight. Excessive weight can raise the risk of venous insufficiency and impede the normal function of the lymphatic system. Swelling and lymphedema in a larger body part, such as the lower leg, can increase the risk of recurrent cellulitis.

Cellulitis risk factors

There are several risk factors that can increase the risk of developing cellulitis:

  1. Middle age and older
  2. Overweight/obesity
  3. Diabetes mellitus
  4. Peripheral vascular disease
  5. Autoimmune disease
  6. History of cellulitis
  7. Malnutrition
  8. Chronic steroid use
  9. Chronic kidney disease
  10. Recent surgery or injury to the skin

Some of these risk factors may be patient modified or provider managed to decrease a patient’s risk of developing recurrent cellulitis.

Cellulitis complications

Significant complications from cellulitis are not common but can be serious. These include:

  1. Tissue damage and tissue death (gangrene)
  2. Bacteremia and sepsis
  3. Septic arthritis
  4. Osteomyelitis
  5. Endocarditis
  6. Lymphangitis
  7. Orbital abscess (with orbital cellulitis)
  8. Optic nerve damage and blindness (with orbital cellulitis)

Cellulitis wounds

At times, cellulitis may cause the skin to develop an open wound. Patients should be taught to wash any newly opened areas with a mild soap and water, cover the open area with a clean, sterile bandage and contact their medical provider.

An open wound is a perfect route for bacteria to cause a cellulitis infection. Cuts, bites, piercings, eczema, chronic ulcers, tattoos, intravenous drug use sites, and athlete’s foot are some common ways bacteria may be introduced into the deeper layers of the skin.

Treated cellulitis should show signs of improvement within ten days. During this timeframe, pain, redness, and swelling should begin to decrease. Patients with weakened immune systems or chronic medical conditions may take longer to show signs of improvement and healing.

Cellulitis wounds that do not improve within seven to 10 days should be reevaluated by a medical professional for possible treatment changes. Patients should seek emergency treatment if the infection appears to be spreading quickly, if the skin turns black, or the patient develops fever, chills, nausea, or vomiting.

Early diagnosis, treatment, and monitoring of cellulitis is the key to successful resolution of symptoms. Empowering our patients with self-care measures and lifestyle modifications can help remove your patients from the cycle of recurrent cellulitis.

If you're interested in expanding your knowledge of wound care, networking with colleagues, or seeing the latest wound care products and technology, register for the Wild on Wounds (WOW) conference August 14–17 in Phoenix, Arizona.

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Tara Call Triplett, RN, WCC, CHFN

Tara Call Triplett has over 20 years of experience as a registered nurse and is the founder of Call to Health Communications. She is nationally certified in both wound care and heart failure. Triplett currently leads an amazing team of clinicians at an award winning outpatient wound care clinic. She has a passion for teaching and mentoring the next generation of wound care clinicians.

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