Focus on Cellulitis

WHAT IS CELLULITIS?

Cellulitis is an acute infection of the skin and the soft tissues below it.

It appears as a red, inflamed, swollen area of skin that feels warm/hot and tender, that may spread rapidly to include the whole limb. Cellulitis can be a potentially serious complication of lymphoedema or a possible triggering factor of lymphoedema in an "at-risk" limb. For these reasons, it is important to be aware of what cellulitis is, how to reduce the risk of getting it in the first place, how to recognize it, and to know what action to take if you do get cellulitis.

WHAT CAUSES CELLULITIS?

Intact skin provides an effective barrier and 'defence' against the bacteria that normally live on it. Cellulitis can happen when bacteria invade the tissues through a crack or break in your skin. Any opening or disruption of the skin - such as from cuts, scratches, burns, dermatitis, puncture wounds, an ulcer, athlete's foot (tinea) and even simply dry, flaky skin - provides a possible site for the bacteria to enter, thrive and multiply in the tissues, causing infection. Some insect or spider bites can also transmit the bacteria. Cellulitis is most commonly caused by the bacteria staphylococcus aureus and/or streptococcus.

LYMPHOEDEMA AND CELLULITIS:

Having lymphoedema increases the risk of getting cellulitis. WHY?

• The swollen tissue from lymphoedema is more prone to damage. The swelling may cause reduced blood flow to the skin, thus less nourishment of the skin. The skin tends to become dry and flaky.This makes the limb vulnerable to infection as cracks of the skin can provide entry points for the bacteria
• The lymph nodes normally act as 'filters', removing and helping to destroy bacteria that is carried to them by the lymph fluid, helping to fight off any infections. The limb is more prone to cellulitis if the lymph nodes have been removed through surgery, as there is lowered protection.
• The stagnant, protein-rich lymph fluid in the swollen tissues of lymphoedema provides an ideal environment for bacterial growth.
• Cellulitis often worsens the lymphoedema as it overloads the lymphatic system and can damage the lymphatic vessels.
• Uncontrolled lymphoedema thus may hinder the healing process, with bacteria not fully eradicated and laying dormant, leading to recurrent cellulitis.

WHAT ARE THE SYMPTOMS OF CELLULITIS?

Often the first sign of cellulitis is increased pain or tenderness of the lymphoedema limb or body part, often similar to 'flu-like' symptoms or aching involving that limb. Following this is usually a sudden onset of an area of redness, blotches, or red streaks or rash on the skin of the involved limb. These tissues become warm/hot, swollen and tender. The skin may look tight and glossy. The person with cellulitis may also develop a high fever, chills, sweats, shaking, and a general malaise (ill feeling). The area of redness can spread rapidly as the cellulitis worsens.

HOW DO YOU TREAT CELLULITIS?

PROMPT treatment with oral antibiotics (such as penicillin) will resolve the cellulitis usually within a minimum of 10 - 14 days. Seek medical attention at the first signs of an acute attack of cellulitis as only a medical doctor can prescribe antibiotics. STOP current lymphoedema treatment, including massage and compression during this acute phase, so as not to spread the infection. Rest and elevate the affected limb. You can exercise the foot/ankle for legs; or the fingers, hand/wrist for arms whilst in elevation. It is vital to diagnose and treat cellulitis early, as left untreated, severe cases can spread the infection to the rest of the body. Severe cellulitis may require antibiotics intravenously (via a drip) in hospital.

Once the infection starts to clear up, and the symptoms subside, the skin will be very dry. Apply a suitable moisturiser to the skin. Consult your lymphoedema therapist and restart your massage and compression to keep the swelling in control.

Low dose daily antibiotics are often recommended long term for those who have recurrent attacks of cellulitis, as a preventative measure. Treatment of your lymphoedema to reduce the amount of swelling and to keep the lymphoedema in control may also help. When travelling, always carry antibiotics or a prescription with you.

REDUCING THE RISK OF CELLULITIS

• KEEP YOUR LYMPHOEDEMA DOWN AND IN CONTROL. Look after your skin!!
  THE PRIMARY GOALIS TO LOOK AFTER YOUR SKIN TO IMPROVE THE BODY'S NATURAL DEFENCES TO INJURY.Clean with a non-drying cleanser, and moisturise daily to keep skin supple. Dry well between fingers and toes and use antifungal cream if you have tinea.
• Take precautions, such as wearing gloves and long sleeves when gardening. Try and avoid cuts, scratches, injections, insect bites, burns and sunburn on your lymphoedema limb. Wash any breaches of the skin and apply antiseptic cream. If the area becomes red or inflamed, see your doctor PROMPTLY for antibiotic treatment.

© Lymphomation, Winter 2004