Excerpt from Cellulitis

Synonyms, Key Words, and Related Terms: infection of the skin, skin infection, soft tissue infection, infection of the soft tissue, Streptococcus pyogenes, S pyogenes, Staphylococcus aureus, S aureus

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Background

Cellulitis is an acute infection of skin and soft tissues characterized by localized pain, swelling, tenderness, erythema, and warmth.

The eMedicine Emergency Medicine article Cellulitis and the Medscape CME course Managing the Complicated Skin and Soft Tissue Infection may be of interest.

Pathophysiology

Cellulitis usually follows a break in the skin, such as a fissure, cut, laceration, insect bite, or puncture wound. Facial cellulitis of odontogenic origin may also occur. Patients with toe web intertrigo and/or tinea pedis and those with lymphatic obstruction, venous insufficiency, pressure ulcers, and obesity are particularly vulnerable to recurrent episodes of cellulitis.^{1, 2, 3} Organisms on the skin and its appendages gain entrance to the dermis and multiply to cause cellulitis. The vast majority of cases are caused by Streptococcus pyogenes or Staphylococcus aureus. Occasionally, cellulitis may be caused by the emergence of subjacent osteomyelitis. Cellulitis may rarely result from the metastatic seeding of an organism from a distant focus of infection, especially in immunocompromised individuals. This is particularly common in cellulitis due to Streptococcus pneumoniae and marine vibrios.

Frequency

United States

Because cellulitis is not a reportable disease, the exact prevalence is uncertain; however, it is a relatively common infection. A 2006 study found an incidence rate of 24.6 cases per 1000 person-years.⁴

International

Cellulitis has been found to account for approximately 3% of emergency medical consultations at one United Kingdom district general hospital.

Mortality/Morbidity

Cellulitis generally is a localized infection. Most patients treated appropriately recover completely. Mortality is rare (5%) but may occur in neglected cases or when cellulitis is due to highly virulent organisms (eg, Pseudomonas aeruginosa). Factors associated with an increased risk of death are the presence of concurrent illness (eg, congestive heart failure, morbid obesity, hypoalbuminemia, renal insufficiency) or complications (eg, shock).⁵

Race

No racial predilection has been noted.

Sex

No predilection for either sex is usually reported, although a higher incidence among males has been reported in one study.⁴

Age

No age predilection is usually described; however, recent studies found a higher incidence of cellulitis in general among individuals older than 45 years.^{2, 4} Moreover, cellulitis at certain anatomic sites may show a predilection for persons in certain age groups.

Facial cellulitis is more common in children younger than 3 years.
Perianal cellulitis is predominantly a disease of children.⁶

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