Dear Doctor Column, September 2, 2002

Question:

Last year I had two occurrences of swelling on the right side of my face, with my right eye swollen shut. My doctor called it cellulitis and said it could be fatal if it reached the brain. What can you tell me about this?

Answer:

Cellulitis is an infection of the skin and underlying tissue caused by streptococcal, staphylococcal, or other bacteria. Enzymes produced by the bacteria can destroy skin cells. The infection spreads over the area for about 2 days and can involve the tissues below the skin. This infection is serious and should receive immediate medical attention. Cellulitis most frequently occurs on the face, arms, or legs, but can occur anywhere. Facial infections are found mostly in infants and the elderly.

The infection typically begins in an area of broken skin, such as a cut, scratch, blister, splinter, or bite (animal, insect, or human), that is red, glossy, painful, and warm to the touch. The most severe complications of cellulitis are meningitis and blood poisoning (if the bacteria get into the bloodstream).

Meningitis can occur if the bacteria get into the central nervous system from the bloodstream or directly from the soft tissues around the eye and sinuses. Cellulitis around an eyelid is called preseptal cellulitis. It causes a rash that might be painful or itchy. If the bacteria get behind the seal where the eye meets its socket, the condition is called orbital cellulitis. This medical emergency causes fever and impaired vision; it requires immediate treatment to prevent meningitis or eye damage.

If the infection gets into the lymphatic system or the bloodstream, red lines may appear under the skin stretching ahead of the main rash. Cellulitis also can cause fever, chills, sweats, and nausea.

Cellulitis is usually worse for those who have problems with the immune system that impair the body's resistance to infection. These include conditions such as diabetes and HIV infection.

A doctor can usually recognize cellulitis from the skin's appearance. A wound culture and blood tests are necessary to determine the organism causing the cellulitis and to select the best antibiotic. Treatment is focused on controlling the infection and preventing complications. Analgesics may be needed to control pain.

Several types of antibiotics are used to treat cellulitis, based on the cause and severity of the infection and on the presence or absence of other medical conditions. Uncomplicated cellulitis should start to clear after just a few days of treatment. However, it is very important to finish the prescribed medicine, even if the symptoms go away, to prevent a recurrence.

When antibiotic treatment begins, restrict movement of the affected area and rest in bed until the infection and any fever subsides. Once the infection starts to improve, normal activities can be resumed. Elevating the affected area so that it is higher than the heart will reduce swelling and pain. Warm compresses increase the blood flow to help fight infection. Serious infections may require antibiotic injections or even hospitalization for intravenous (IV) antibiotics.

To avoid cellulitis, you should:

• Wear protective equipment when playing outdoor sports. Soil forced into cuts and scratches is a common cause of cellulitis.
• Wear long sleeves and long pants when hiking in the forest to decrease the chance of scratches and other injuries.
• Do not go outdoors in bare feet.
• Avoid swimming in salt or fresh water with broken skin.
• Clean cuts, abrasions, and other skin injuries thoroughly with soap, and keep wounds and sores clean and protected to promote healing.
• See a doctor for large or infected cuts or wounds inflicted by animals.

If you would like to schedule an appointment with a UAB physician, call UAB HealthFinders at 205-934-9999 or toll-free at 800-822-8816. Registered nurses are available to take your calls Monday through Friday, 8 AM to to 5 pm (CST).