What Is Cellulitis?
Cellulitis is a common, potentially serious bacterial skin infection: a non-necrotizing inflammation of the skin and subcutaneous tissue from acute infection that shows as a swollen, red area that feels hot and tender.
Pathophysiology
Cellulitis usually follows a break in the skin that was not covered or cleaned well: puncture wounds, fissures, or lacerations. Organisms reach the dermis and multiply. The skin turns swollen, red, and tender, often with fever. Untreated, the infection moves into deeper layers and reaches the lymph nodes and bloodstream, spreading through the body.
Statistics and Epidemiology
Cellulitis is not a reportable disease, so exact prevalence is uncertain, but it is common across all racial and ethnic groups. Incidence is higher in people older than 45 years. A population-based study put the incidence at about 24.6 cases per 1000 person-years, with the lower extremity the most common site (StatPearls). Skin and soft tissue infections account for a large and rising share of outpatient and emergency visits in the United States. In one general hospital in the United Kingdom, cellulitis accounted for about 3% of emergency medical consultations.
Causes
Several factors raise the risk. A weak immune system lets bacteria take hold easily. Breaks in the skin from eczema or athlete's foot give bacteria an entry point. Intravenous drug use opens the insertion site as another portal for pathogens. Diabetes slows wound healing, and a wound left open longer invites infection.
Clinical Manifestations
The signs sit right on the skin. There is tenderness and pain at the developing site. Inflammation spreads as the infection moves into deeper layers. A rash or sore spreads quickly. The skin looks tight, glossy, and shiny from swelling. Pus and abscess form as it worsens, and fever rises as the body fights the infection.
Prevention
Preventing cellulitis beats treating it. Clean any break in the skin right away and apply antibiotic ointment aseptically. Cover the wound with a clean bandage and change it regularly until a scab forms. Watch the site for signs of infection: tenderness, discharge, and pain.
Complications
Untreated cellulitis can turn severe. Pathogens entering the bloodstream cause blood infection and damage surrounding tissue. The infection can burrow through skin layers to reach bone. Lymph vessels can become inflamed and infected. The worst case is gangrene, from lack of oxygen to the tissue.
Assessment and Diagnostic Findings
A blood test rules out systemic or blood infection. A wound culture identifies the causative organism. Ultrasound can detect an abscess and guide treatment.
Medical Management
Management centers on eradicating the infection. Most patients respond well to antibiotics. For uncomplicated cellulitis the Infectious Diseases Society of America recommends a 5-day course, extended only when the infection has not improved by day five (IDSA). An abscess needs incision and drainage to resolve, whatever the pathogen. Analgesics are prescribed in some cases. Rest is necessary until symptoms improve; keep the affected area raised above the heart to reduce swelling.
Surgical Management
When the affected tissue reaches its worst state, surgery may be needed. Amputation is required only if the area becomes gangrenous or necrotic.
Nursing Management
Management depends on the severity of the affected area.
Nursing Assessment
Assess past medical history for comorbid conditions that raise cellulitis risk. Review surgical history, since a prior procedure may have led to wound infection. Focus the physical exam on the affected area.
Diagnosis
Common diagnoses: impaired skin integrity related to altered primary defenses, disturbed sensory perception related to impaired nerve stimulation, and risk for situational low self-esteem related to disturbed body image.
Nursing Care Planning and Goals
Desired outcomes: timely wound healing without complication, optimal nutrition and physical well-being maintained, participation in prevention and treatment, and increased self-esteem.
Nursing Interventions
Care rests mainly on the antibiotic regimen. Obtain a specimen from draining wounds to guide therapy. Watch for complications to track wound healing. Keep the area clean and dry and dress wounds carefully to support repair. Use appropriate barrier dressings and wound coverings to protect the wound and surrounding tissue. Consult a wound specialist for potentially serious wounds.
Evaluation
Confirm the patient meets the planned outcomes: wound healed on time without complication, nutrition and physical well-being maintained, active participation in prevention and treatment, and self-esteem improved.
Discharge and Home Care Guidelines
Care continues at home with help from significant others. Help the patient and family understand and follow the medical regimen. Teach stress reduction to cope with the situation. Stress proper fit of clothing and shoes to avoid reduced sensation or circulation.
Documentation Guidelines
Document the wound's characteristics, causative factors, the condition's impact on personal image or lifestyle, the plan of care and those involved in planning, the teaching plan, responses to interventions and teaching, attainment of or progress toward desired outcomes, and modifications to the plan of care.
Frequently Asked Questions
What is cellulitis? Cellulitis is a common bacterial infection of the skin and the tissue just beneath it. It shows up as a swollen, red area that feels warm and tender, and it can spread quickly if it is not treated (StatPearls).
Is cellulitis contagious? No. Cellulitis does not pass from person to person. It develops when bacteria enter through a break in the skin, such as a cut, crack, puncture, or area of eczema or athlete's foot.
How is cellulitis treated and for how long? Antibiotics are the foundation of treatment. For uncomplicated cellulitis the IDSA recommends a 5-day course, extended only if the infection has not improved by day five. An abscess also needs incision and drainage (IDSA).
What should a nurse monitor during treatment? Mark and watch the borders of the red area, track temperature and pain, elevate the limb above heart level, and watch for signs the infection is spreading deeper or toward the bloodstream, including spreading redness, increasing pain, fever, or confusion.
When does cellulitis become an emergency? Untreated cellulitis can reach the lymph nodes and bloodstream and lead to sepsis, or burrow to deeper tissue and bone. Rapidly spreading redness, severe pain out of proportion to the skin findings, blistering, or systemic signs such as high fever and low blood pressure need urgent evaluation.
Who is at higher risk for cellulitis? People with a weakened immune system, diabetes, chronic skin conditions that break the skin barrier, lymphedema or poor circulation, obesity, and a history of prior cellulitis are at greater risk.