Introduction to Cellulitis and Common Symptoms
[00:00] Hey Doc, does this look infected? Okay, so this is a common question. You got a red swollen extremity particularly your lower legs You're wondering if you have cellulitis. So we're gonna talk all about what it is, how you diagnose it, how you treat it We brought a guest. Dr. Tom Warren infectious disease with us today. Welcome, Dr. Warren. Thank you for having me. Alright, so cellulitis fun to say
What is Cellulitis and How it Occurs
[00:20] but not fun to have. What is it? So cellulitis is a bacterial infection of the skin and the skin structure. Alright, so you've got bacteria infecting your skin. You're the biggest organ in your body now. Your skin is now infected. Does it hurt? Yeah, it does hurt. It's red, it's inflamed, it's swollen and it hurts. Okay, so those are your symptoms.
[00:40] symptoms of pain, you see redness, swelling, you go to the doctor and physical examination, they're going to see a red area in your skin that is tender to touch and it's quite a sharp demarcation of redness usually but not always. That's right. And the trouble is, people are like, well, where is this bacteria coming from? We are covered in bacteria all the time. A lot of people
How Cellulitis Develops and Risk Factors
[01:00] don't really realize that. And then what happens is when you become compromised in some way because of your medical condition or because of a penetrating injury or a blister or an athlete's foot or whatever, it weakens that barrier that skin is providing to the bacteria now or in a place where they're not supposed to be. That's right. And do you always have to breach the skin to get that infection? Or can it happen without
[01:20] actually breaching the skin. It can happen without an obvious breach of the skin. Okay, so you don't need to cut yourself or poke yourself with anything to get this. But most of the time that is what happens that cause the cellulitis. But sometimes it can happen without even that occurring. So you go to your doctor and they're looking at your, say your ankle, how are they going to make that diagnosis? Are there any specific tests or things that they do or things
Diagnosing Cellulitis Clinically
[01:40] things that they see that says, yeah, I think this is cellulitis. Yeah, so there's not usually any specific tests. We usually basic clinical signs and symptoms. So if it's a red leg just on one side, usually it's painful. It doesn't go away with like leg elevation. Those are usually the clinical manifestations that are indications for
[02:00] treatment. And the reason that last one's significant because a lot of people as they get older, their veins start to fail them. So they have chronic dependent edema or even something called lymphedema where the leg always looks kind of red and swollen and angry. So if you raise it up and the blood goes away and the redness goes away, that means it's not cellulitis. Yeah, there are other conditions that can mimic it. I remember getting called to the ward
[02:20] ones for a postoperative patient and the nurse was worried about a cellulitis and I went up with a towel and some water and I wiped off the red prep that we used before surgery and so there I cured. You look like a superstar. Where there's regular testing, so there's no specific test, is there any role for swabbing a cellulitis because we swab a lot of stuff in the hospital. We're not sure where it is, swab, colon infectious disease and I'm sure
Why Swabs Aren’t Helpful and Diagnosis is Clinical
[02:40] doctor is like really just stop swabbing some things. You're calling me too much. Yeah, no swabs of the skin or even swabs of superficial wounds really aren't helpful. Not useful. Okay. So it's a clinical diagnosis. Okay. Based on the history of the physical examination and now it is caused by bacterial infection in the skin. How do we treat it?
[03:00] So the treatments commonly used antibiotics, penicillin and derivatives like that because the most common cause of cellulitis are streptococcus species. Okay. Alright. So on speculation, so you don't have to identify the bacteria. Say these are the most common ones. We're going to give an antibiotic that's going to get rid of these. That's right. Over 90% of cellulitis is caused by common bacterial
Treatment Options: Oral vs. IV Antibiotics
[03:20] caucus. Okay. Okay. And are these antibiotics given orally, like in a pill form or are they given intravenously, like through an IV? It depends on the severity, but it can be treated with pill antibiotics. Okay. Okay. So can be pill if it's very severe or not getting better with pill antibiotics and you have to start some IV antibiotics. That's right. How long would the course typically be?
Duration of Treatment and Risk of Spread
[03:40] So usually about seven days. Again, if it's more severe or there's complicating features like a wound in a diabetic patient, then we can treat longer. But the usual course is about seven days. And obviously the primary concern is the limb that you're talking about. But is this something that can spread and lead on to more serious things? It can. Yeah. It can occur any
[04:00] anywhere in the body, most commonly in the leg and it can progress to involve the bacteria in the blood or other areas. Okay, so this is something that can be dangerous so it should be treated. Can your body deal with it on its own sometimes if the infection is small enough without antibiotics or is it always, always, always need antibiotics?
Self-Monitoring and When to Seek Urgent Care
[04:20] No, usually if it's relatively minor in a small area, your body's immune system can deal with it on its own. Thank you, body. But in some cases, you need to get treated. That's right. And one way to assess is if you're on your own at home and you have a red area on your leg and you're not sure if you need to do something about it, some people will use a pen to mark the area. So then you can say, well, look,
[04:40] yesterday it was here and now today or the next day it's here. As long as it's regressing or not increasing that's probably okay, but particularly concerning is if that area is spreading and if it's spreading quickly, this requires immediate attention, probably not even by your family doctor, probably going to the emergency room. So if it's spreading in a period of minutes or hours, definitely seek more urgent attention. Yeah, that's one of the questions
Success Rates and Risk After Surgery
[05:00] I always ask you just about any condition, is this getting worse or is this getting better? And that really guides treatment. Okay, so we've talked about what it is, the bacteria that cause this infection and treatment. Now, is treatment always successful or most of the time successful or rarely successful? Most of the time it's successful, yeah.
[05:20] Again, we base the deterioration on treatment on how people respond as well. And so sometimes it's slower to resolve if there's complicating features like a bad lymphedema or swelling of the leg. But most of the time it is successful. Okay. And it is fairly common. This is one of the most common complications that we'll see after a surgical intermentation.
[05:40] prevention because we breach the skin and we really try hard to be sterile in the OR and keep the wound clean and everything like that. But just sometimes you can get a cellulitis after a surgical incision. So that's one of the things your surgeon is going to be checking for when you go back for that first follow up and the sequential follow ups. Okay, anything we can do to reduce the chances of getting a
Preventing Cellulitis: Hygiene, Compression, and Foot Care
[06:00] Is there any advice we can give people to say, hey, do this to try to prevent it? Yeah, a big one is just swelling of the leg. So as people age, their veins and arteries don't work as well and that can lead to swelling in the leg. So compression stockings, for instance, can be very helpful to prevent that. And another cause is athlete's foot. And so that's a superficial fungal infection. And so if there's
[06:20] any of those manifestations in their foot, they'll do what's easily treatable as well. And that's treated topically with a topical cream? Yeah, with a topical antifungal cream. Okay. And that's a fungal infection. The cellulitis is a bacterial infection. So it's two different things, but one can lead to the other. So reduce the swelling and good hygiene. Just keep that lead clean.
[06:40] in
[07:00] tricky because one of the signs of fracture is swelling and redness and that kind of mimics cellulitis. So you'll see off in your doc, I can't tell if this is just a fracture or if this is a cellulitis, we need to add antibiotic to the cast management or whatever the management was of your fracture. Awesome. Now you know everything you need to know, maybe more than you wanted to
[07:20] know about cellulitis. If you have a comment, please leave it. Let us know your experience with cellulitis because this is so, so common. You are 100% not alone. If you like this video, please like it. Subscribe to our channel. And remember, you are in charge of your own health. Thanks, Dr. Warren. Thank you. We'll see you next time.
