Cellulitis | Arthritis Information

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Well, I woke up this morning and my leg just above the ankle was sort of burning.  I slapped my feet to the floor and started the day, not really thinking too much about it.  This afternoon, sitting here reading through the board and reached down to rub my leg... OUCH!  Really sore!  I take a close look and yep!  Cellulitis! Makes this the third time I have had it in less than a year.

I wonder if it is the suppressed immune system?  Circulation, maybe?  Any one else get this often? 

I know the routine, warm compresses and antibiotics.  I can't see the PCP until tomorrow, too late today (of course!)

UGH!

I think I have that cellulitis infection in my gum again....same lump, same tender feeling, same tender tooth.

How do you get cellulitis?
WTB, it is a bacterial infection that, I assume, enters through a scratch or some type of wound.  That is about the extent of my knowledge of it, other than my recent experience.    Waddie-
 
I just found this- hope it helps
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Cellulitis

And Erysipelas

 
Cellulitis is an infection of the skin and the tissues just below the skin surface. Any area of the skin can be affected but the leg is the most common site. A course of antibiotics will usually clear the infection. If you have a cellulitis of the leg, as much as possible keep your foot raised higher than your hip. This helps to prevent excess swelling which may ease pain. Examples of how to raise your leg in this way are given below.
 

What is cellulitis?

Cellulitis is an infection of the deep layer of skin (dermis) and the layer of fat and tissues just under the skin (the subcutaneous tissues).

Erysipelas is an infection of the skin which is nearer to the skin surface (more superficial) than cellulitis.

In reality, it is difficult to tell how deep an infection is so cellulitis and erysipelas are much the same thing.
 

What causes cellulitis?

The skin is a good barrier against infection. However, a break in the skin from a cut, skin ulcer, injection, athlete's foot, scratch, etc, is a way in which bacteria (germs) can get into and under the skin. A tiny cut is all that is needed to allow bacteria in.

The bacteria may then multiply and spread along under the skin surface to cause an infection. Although a cut, graze, etc, is found in many cases to be the root cause, sometimes the infection occurs for no apparent reason with no break in the skin found. A variety of bacteria can cause cellulitis.
 

Who gets cellulitis?

Cellulitis can affect anyone. However, you are more prone to cellulitis if you:
  • Have athlete's foot (see below).
  • Have swollen legs (for various reasons), or are overweight or obese.
  • Have previously had an episode of cellulitis.
  • Have a poor immune system - for example, if you take steroids or chemotherapy.
  • Have poorly controlled diabetes.
 

A common cause of cellulitis is due to athlete's foot

Athlete's foot is usually a mild fungal skin infection. However, it can cause tiny cracks in the skin between the toes. Bacteria may then get under the skin and travel up to cause a cellulitis in the calf (but without an apparent infection of the foot).

The cellulitis can be treated, but it may recur if the athlete's foot is not also treated. Unless athlete's foot is looked for, it can easily be missed as the source of the problem. Some people have two, three or more bouts of cellulitis before it is realized that the infection in the leg is due to the minor skin cracks between the toes! People more prone to cellulitis such as those with swollen legs and the obese should be careful to treat any athlete's foot promptly. Itchiness between the toes is the first sign of athlete's foot. (See separate leaflet called 'Athlete's Foot' for details.)
 

What are the symptoms of cellulitis?

The lower leg is the most common site for cellulitis to develop. However, cellulitis can affect any area of the skin. Affected skin feels warm, may look swollen, and looks red and inflamed. The infected area may spread and is usually tender. The nearest glands may swell and become tender. This is because they are fighting off the infection to stop it spreading to other parts of the body. For example, the glands in the groin may swell during a cellulitis of the leg.

You may feel unwell and have a fever. Indeed, the first symptom is often to feel feverish and shivery for up to 24 hours before any changes to the skin appear.
 

Is cellulitis serious?

Cellulitis can range from a small area to a large, spreading infection affecting a large area of skin. Therefore, cellulitis can range from mild to serious. Without treatment, a 'battle' is fought between the immune (defence) system of the body and the invading bacteria. Often, the body would fight off the bacteria and the infection would clear. However, a spreading cellulitis that is getting worse can be quite worrying. Therefore, treatment is usually advised as soon as cellulitis is diagnosed to make sure it does not spread and become serious.

In particular - cellulitis around the eye (periorbital cellulitis) needs urgent treatment. This mainly affects young children and initially causes redness and swelling of the eyelids.

Possible complications of untreated cellulitis are:
  • Septicaemia (blood poisoning) which can be life-threatening.
  • An abscess forming (a ball of pus in the infected area).
  • Muscle or bone infections which can be serious.
  • A cellulitis around an eye can spread to infect the brain.
  • Bacteria that get into the bloodstream can cause an infection of the heart valves.
Also, if the cellulitis is severe before it is treated, it can leave long-term damage to lymph drainage from affected tissues. This means that in some cases the swelling of tissues may remain, become worse, and be permanent after the infection has gone.

So, the take home message is - if you have a patch of skin that is red, warm, and it seems to be getting larger, then see a doctor as soon as possible. With treatment, most people with cellulitis make a full recovery without any complications developing.
 

What is the treatment for cellulitis?

Antibiotics

A course of antibiotic tablets will usually clear cellulitis. Symptoms should soon ease once you start antibiotic tablets. (However, there may be an initial increase in redness when treatment is started before it starts to fade.) Tell a doctor if the area of infection continues to spread or you become worse after you start antibiotics. (Some bacteria are resistant to some antibiotics, so a change in antibiotic may be needed if the infection does not improve with the first antibiotic.)

If you have severe cellulitis, or have a mild cellulitis that does not improve with antibiotic tablets, then you may need antibiotic injections. Some people with severe cellulitis become very unwell and need to be treated in hospital with antibiotics given straight into a vein.
 

Elevation

Elevating (raising) the affected body part uses gravity to help prevent excess swelling which may also ease pain. Do this as much as possible until the infection clears.

If you have a cellulitis of the leg, 'raised' means that your foot is higher than your hip so gravity helps to reduce the swelling. Many people on being told to elevate a leg put it on a chair or foot-stool. This is rarely sufficient (even if the chair reclines) as the ankle has to be higher than the hip for elevation to be useful.

The easiest way to raise your leg is to lie on a sofa with your heel up on the arm of the sofa (but avoid pressure on the calf). Or, lie on a sofa with your foot on two or three thick cushions. When in bed, put your foot on several pillows so that it is higher than your hip. Alternatively, empty a deep drawer and put it under the mattress at the foot of your bed.

You may need to keep your foot elevated as much as possible for a few days. However, to aid circulation, you should go for short walks every now and then, and wiggle your toes regularly when your foot is raised.

If you have cellulitis in a forearm or hand, a high sling can help to raise the affected area.
 

Other things that may help include:

  • Painkillers such as paracetamol or ibuprofen can ease pain and reduce a fever.
  • Treat athlete's foot if it is present. (See leaflet called 'Athlete's Foot' for details.)
  • Use a moisturiser cream and soap substitute on the affected area of skin until it heals. This helps to prevent the skin from becoming dry and damaged.
 

What to look out for

Most people with cellulitis recover fully without any complications. However, serious and life-threatening complications may develop in some cases. These are mentioned above. In addition, a condition to be aware of which is similar to cellulitis and is sometimes at first mistaken for cellulitis is called necrotizing fasciitis.
 

Necrotizing fasciitis

This too is an infection that affects the skin and the tissues under the skin (the subcutaneous tissues). It is similar to cellulitis but is always very serious. Various bacteria can cause necrotizing fasciitis, but most commonly it is due to the streptococcus bacterium.

Necrotizing fasciitis is one of the fastest-spreading infections known. It is sometimes called the 'flesh eating' disease. However, the bacteria that cause this infection do not 'eat flesh'. What happens is that they release toxins (poisons) which destroy the nearby tissues such as skin and muscle tissue.

As with cellulitis, the infection of necrotizing fasciitis typically starts from a wound in the skin - and this is often very minor such as a scratch. This allows bacteria into the skin. Typically, the affected skin at first becomes very painful - but in the early stages this is often without any obvious redness or inflammation of the skin. The disease then progresses rapidly (over hours) and the affected tissues then typically become swollen, red, and may blister. Typically you feel very ill - which may seem out of proportion to the 'look' of the skin at first.

Fairly quickly though the affected skin becomes violet or purple, blistered and dies (necroses) along with the subcutaneous tissues. The toxins and infection can affect the rest of the body causing organ failure. Severe cases progress within hours and the death rate from this infection is high (30% or more), even with treatment.

So, symptoms to take special note of are:
  • Pain 'out of proportion' to the look of the skin changes.
  • Feeling unwell and becoming ill 'out of proportion' to the look of the skin.
  • Symptoms that get worse rapidly - either skin symptoms, or how you feel generally.
  • Affected skin that goes dusky, purple or blistering.
Necrotizing fasciitis is a medical emergency - you need immediate treatment.

But remember, most cases of infected skin are cellulitis and are not necrotizing fasciitis. Cellulitis is common and necrotizing fasciitis is rare. This final section is added for the sake of completeness and for you to be aware of what to look out for.
WTB, thank-you so much!  I see under the "Who gets.." section the reasons why I am getting it!  Sheesh, another RA break... yea!  I guess that is why I have had this fever feeling the last few days!  I just thought it was RA, guess thats what I get for assuming!

Thanks again!
Yes I know! I guess my dr. was right when he said the MTX might have caused it for me and now I think I have it again. What a coincidence it's been since my dose was increased...
 
Make sure you elevate your leg!
 
I guess I better call the dentist. I'm hating to go off the MTX again for this- last time it through me into a flare!
It must be the cellulitis season. I have had what I thought was a weather-related flare in my left foot. After several days of limping round on it I saw the podiatrist in the hallway of the local hospital after a conference on Saturday and he pulled me into an examination room, looked at my foot, shook his head at me, gave me a double whammy of antibiotics and kenalog, one in each 'cheek' and told me to go soak my foot (I suppose I was fortunate that it was not my head, say eh?)

I think a favourite beverage party is in order!
Snow, my garden gates will be open!  I really should wear long pants but how  Waddie, how are you? Your DH? Is your leg improving and his hand? I was also wondering how the "cellulitis crew" was doing.  I get preorbital cellulitis about once year.  It seems once you get it once, you have a greater chance of getting it again.  Lucikly, I know exactly what if feels like and can get to the opthomologist before it gets to advanced.  The first time, I didn't take it very seriously.  Dr. gave me the facts and made me come every other day for checkups.  So, I always worry when people bring up cellulitis.
 
Let us know how you are doing.
My goodness.... is there a cellulitis season? Good luck to you all,
CathyMarie
Well...ready to hear my saga? Pour yourself a refreshing beverage and sit back.

I had a 9:30 AM appoint this morning with the podiatrist. I arrived in time to find a parking place and hike across the acre of black top. Just before I got to the sidewalk leading to the doctors door a delivery truck literally careened around the corner and in my anxiety to get out of the way of that truck bearing down on me I tried to scurry along and ended up tripping over a cement bumper and falling like that proverbial ton of bricks.

The upshot: I have a fractured left lateral ankle, two metatarsal fractures, a very tender left ribcage, shoulder, and arm.

I am in a Cam-walker and have been confined to sitting with my leg elevated.

Some days everything you do turns to gold, other days...
OH NO SHUG!  That is the worst possible news!  I feel so awful for you and I know my words are woefully inadequate!  The shoulder and arm issues would be just about as bad as the fractures to me.  It is easier to keep a leg immobile and elevated, for me anyway.  Did you have x-rays of your chest and arm?  I hope you were able to browbeat the driver!  You need some justice! Waddies, thank you. Your words are a very nice panacea.

X-rayed, quite literally, top to bottom. Aside from a nicely arrayed (and growing) set of bruises, nothing cRaCKed but the ankle and metatarsals and a very badly bent pair of eyeglasses.

Of greater discomfort is that I have had to cancel a dive permit for next week and will be effectively out-of-the-loop for the next two dives.

So, instead of caving I will simply hang around here and create havoc!
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