Skin Infection: Erysipelas and Cellulitis

_______________________________________________________________________

KEY POINTS

• Erysipelas is an infection of the upper layers of skin. Cellulitis is an infection of the skin and the tissue under it. Both are caused by bacteria and need to be treated right away.
• The infection is treated with an antibiotic. If you have an infection with a collection of pus, your healthcare provider may drain the infection.
• Take your antibiotic medicine for as long as your healthcare provider prescribes, even if you feel better.

________________________________________________________________________

What are erysipelas and cellulitis?

Erysipelas is an infection of the upper layers of skin. Cellulitis is an infection of the skin and the tissue under it. Both are caused by bacteria.

Skin infections are serious and need to be treated right away. Without treatment, the infection can damage skin tissues and spread quickly to other parts of your body. A skin infection that is not treated right away may lead to:

• Infection in your blood
• Tissue death (gangrene) and possible loss of a body part (amputation)
• Infection in your eyes, causing blindness
• Infection in your brain (meningitis)
• Death

What is the cause?

Many different types of bacteria can cause skin infections. The bacteria get into the body through a break in the skin.

You are more likely to get a skin infection if:

• You have a rash, cut, bite, sore, or IV drug injection site
• You have a medical condition such as diabetes, HIV/AIDS, or cancer that makes it hard for your body to fight infection
• You have an infection in the mouth, teeth, or sinuses
• You are obese
• You have swelling, especially in the legs, that lasts for many days
• You have had radiation treatment that left you with a wound on your skin
• You have lymphedema, which can happen when the lymph system is blocked and cannot drain fluid from the tissues. This may be caused by:
  • Infection
  • Radiation
  • Injury
  • Cancer
  • Prior surgery to remove cancer and nearby lymph nodes
  • Problems with the lymph system that you were born with

What are the symptoms?

Symptoms may include:

• Redness, swelling, and skin that feels hot to the touch
• Extreme tenderness or pain
• Swollen and tender lumps (lymph nodes) in the neck, armpits, or groin
• Red streaks that spread away from the wound or sore
• Fever and chills
• Fluid-filled sores
• Fast heart beat

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. Tests may include:

• Blood tests
• X-rays if there is a concern about a bone infection
• Ultrasound, which uses sound waves to show pictures of the tissue if there is a concern about a blood clot
• CT scan, which uses X-rays and a computer to show detailed pictures of the tissue if there is a concern about a sinus infection or brain infection
• MRI, which uses a strong magnetic field and radio waves to show detailed pictures of the tissue if there is a concern about a sinus infection or brain infection
• A culture, which is a swab of infected tissue or fluid that is sent to the lab and tested.

How is it treated?

The infection is treated with antibiotic medicine taken by mouth. Your provider may follow-up with you 2 or 3 days after your first visit to make sure the medicine is working. If the infection does not get better, or if the infection is serious, you may need to stay in the hospital to receive antibiotic medicine through an IV.

If you have an infection with a collection of pus, your healthcare provider may drain the infection.

How can I take care of myself?

• Take your antibiotic medicine for as long as your healthcare provider prescribes, even if you feel better. If you stop taking the medicine too soon, you may not kill all of the bacteria and you may get sick again.
• Ask your healthcare provider how to take care of the infected area. For example, your provider may recommend:
  • Keeping the infected area up on pillows (above the level of your heart) when you sit or lie down to decrease swelling and pain
  • Putting a warm, moist towel on the reddened area
• Take pain medicine as directed by your provider.
  • Take nonprescription pain medicine, such as acetaminophen, ibuprofen, or naproxen to treat pain or fever. Read the label and take as directed. Unless recommended by your healthcare provider, you should not take these medicines for more than 10 days.
  • Nonsteroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen, naproxen, and aspirin, may cause stomach bleeding and other problems. These risks increase with age.
  • Acetaminophen may cause liver damage or other problems. Unless recommended by your provider, don't take more than 3000 milligrams (mg) in 24 hours. To make sure you don’t take too much, check other medicines you take to see if they also contain acetaminophen. Ask your provider if you need to avoid drinking alcohol while taking this medicine.
• Ask your provider:
  • How and when you will get your test results
  • How long it will take to recover
  • If there are activities you should avoid and when you can return to normal activities
  • What symptoms or problems you should watch for and what to do if you have them
• Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

How can I help prevent cellulitis?

• Wear gloves and protective clothing when playing, gardening, or working outdoors.
• Clean cuts, scrapes, and other skin injuries well with soap and water as soon as possible.
• Keep wounds and sores clean and dry. You may need to cover some wounds with a bandage to keep them clean and dry. Change bandages every day, Change them more often if they get dirty or wet.
• See your healthcare provider for treatment as soon as possible if:
  • You have a deep wound
  • You have a puncture wound or animal bite especially on the face, hand, or foot, or into a joint
  • Your wound or sore shows signs of infection. Signs of infection include new or worse redness, swelling, pain, warmth, or drainage from the wound. You may have fever, chills, or a headache if an infection is getting worse.
  • You may have a sinus or dental infection. Signs of an infection may include fullness, pressure, or pain in your face or head, toothache, headache, cough, sore throat, or fever.
• If you have diabetes, follow your provider’s instructions for good skin care and keep your blood sugar under good control.