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JAMA Patient Page
May 23/30, 2017

Cellulitis

JAMA. 2017;317(20):2142. doi:10.1001/jama.2017.5205

Cellulitis is an infection of the skin or underlying tissues.

Bacteria can be introduced into the skin through an area of open skin, such as an insect bite. However, in many cases, there is not an obvious site where bacteria entered the skin. Once bacteria are in the skin, they cause redness and swelling that can spread rapidly. Cellulitis can happen almost anywhere on the body but the most common place it occurs is the lower legs.

Symptoms of Cellulitis

Signs of cellulitis include redness of the skin (especially redness that spreads rapidly along the skin), warmth under the skin, and fever. The affected area can be painful. Certain bacteria can cause pus to collect beneath the skin (abscesses) or create blisters (bullae). Many different bacteria can cause cellulitis, but the most common are streptococci (especially beta-hemolytic streptococci) and Staphylococcus aureus.

Some patients are at increased risk of cellulitis, especially those with chronic swelling (lymphedema), those who are obese, and those with diabetes. Sometimes cellulitis can develop at the site of an animal bite or water exposure.

Diagnosis of Cellulitis

Cellulitis is diagnosed by physical examination. Laboratory testing and x-rays are not required. However, with more severe skin infections, studies like computed tomography scans and ultrasound might be done to look for deeper pockets of infection (abscesses).

Treatment

Cellulitis is treated with antibiotics to kill the bacteria involved. Antibiotics can be given by mouth (pills, liquid) in many cases, but in more severe cases, patients may need to be hospitalized for intravenous antibiotics. When an abscess occurs, it should be drained whenever possible. If a patient has frequent episodes of cellulitis, sometimes an antibiotic can be given daily for several weeks or even months to help prevent further episodes.

Preventing Cellulitis

  • Keep skin moisturized to prevent cracks and breaks in the skin, especially the feet.

  • Prevent formation of wounds.

  • Patients with chronic swelling should elevate the affected areas or use compression garments.

  • Take preventive antibiotics if prescribed by your doctor.

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Article Information

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Source: Stevens DL, Bisno AL, Chambers, HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014;59(2):e10-e52.

Topic: Infectious Disease

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