Cellulitis

Overview

Cellulitis, the medical term for skin infection, until recently has been a benign and easy to treat condition, except in those with underlying chronic medical conditions such as diabetes or peripheral artery disease.

Cause

In a normal healthy person, has almost invariably been caused by one of two microorganisms: staphylococcus aureus or streptococcus pyogenes, both of which were sensitive to many commonly prescribed antibiotics. More recently there has been an epidemic of MRSA (methicillin-resistant staphylococcus aureus; see below).

These organisms are considered normal skin flora, meaning that they always live on your skin, but generally don’t bother you. Generally, healthy individuals develop cellulitis when a little bad luck accompanies normal, minor trauma to the skin. Such trauma can include anything from a mosquito bite to a small cut or scratch to a break in skin integrity from intense friction. Obviously, dirty wounds are considered significantly higher risk and are what many people think of when they think of skin infections.

Prevention

Prevention is probably the best approach to skin infections, particularly in an environment remote from traditional medical care. Avoiding significant trauma with well-fitting shoes and gear will reduce friction and skin trauma. When minor cuts and scrapes do occur (e.g. from falls or exposure to aggressive plant species), thoroughly cleaning those wounds that do occur and covering with antibiotic ointment (Neosporin or bacitracin) is important.

Recognizing early signs of skin infection will allow early treatment with systemic antibiotics before it becomes advanced. Signs include redness spreading around a small wound, tenderness, swelling, or perhaps a little discharge or oozing.

Treatment

Very localized infection can be treated with topical antibiotics such as bacitracin or Bactroban (mupiricin) but often, oral antibiotics are necessary for a few days.

One very important element in the management of cellulitis is timely treatment: the time to treat this process is at the moment of recognition. Certain infections (particularly streptococcal infections) can spread extremely rapidly and, in rare cases, become life-threatening in hours. While such aggressive disease is not common, typical cellulitis can still spread rapidly over the first 24-48 hours, turning what is initially a mild and easily treated illness into a serious established infection requiring hospitalization and several days of intravenous antibiotics.

MRSA

MRSA is a species of Staph that has been sweeping around the world in recent years that is resistant to antibiotics commonly used to treat cellulitis. It should be suspected when there is abscess formation within the boundaries of the cellulitis (due to a unique virulence factor). Most infections, however, remain susceptible to traditional antibiotic therapy.