Cellulitis

Who's At Risk?

Cellulitis can occur in infants, and the site of the original injury may not be apparent. Cellulitis can be caused by an accidental injury by the caregiver or by the infant causing self-injury (such as from scratching). Having a weakened immune system is another risk factor for developing a cellulitis infection.

Signs & Symptoms

The most common locations for cellulitis include:

• Lower legs
• Arms or hands
• Face

Cellulitis initially appears as pink-to-red, slightly inflamed skin. The affected skin quickly becomes deeper red, swollen, warm, and tender, and the affected area increases in size as the infection spreads. Occasionally, red streaks may radiate outward on the skin from the site of the cellulitis. Blisters or pus-filled pockets (pustules) may be present.

Cellulitis may occur with swollen lymph glands. Fever and chills are common.

Self-Care Guidelines

There are no self-care treatments for cellulitis. See your infant’s physician immediately or take the infant to the emergency room. If an arm or leg is involved, you can raise (elevate) the affected body part to reduce or prevent swelling.

Treatments

Although your child’s doctor may easily diagnose cellulitis, he or she may wish to order other procedures such as blood tests or a skin biopsy. In addition, the doctor may perform a bacterial culture to find out what type of bacteria may be causing the cellulitis.

In the culture procedure, the doctor will:

1. Penetrate any blisters or pus-filled pockets with a needle, scalpel, or small blade (lancet).
2. Rub a sterile cotton swab across the skin to collect the sample.
3. Send the specimen away to a laboratory for evaluation.

If there are many bacteria present in the sample, the laboratory will usually have some idea of what type it is within 48–72 hours. However, the culture may take a full week or more to produce final results. In addition to identifying the type of bacteria that is causing the cellulitis, the laboratory usually performs a test (antibiotic sensitivity testing) to determine which antibiotics will be most effective in killing off the bacteria.

While waiting for the results from the bacterial culture, the doctor will probably want to start your child on an antibiotic to fight the most common bacteria that cause cellulitis. Once the final culture results have returned, the physician may change the antibiotic, especially if your child is not improving on the one initially prescribed.

Mild cases of cellulitis in otherwise healthy people can be treated on an outpatient basis with oral antibiotic pills or syrups. Common oral antibiotics that are used to treat cellulitis include:

• Dicloxacillin
• Cephalexin
• Trimethoprim-sulfamethoxazole
• Clindamycin
• Erythromycin

However, ill-appearing children who have other illnesses, or those who have cellulitis of the face, may need to be admitted to the hospital for observation and so they can receive injected (intravenous) antibiotics. Common intravenous antibiotics used in hospitals to treat cellulitis include:

• Nafcillin
• Oxacillin
• Cefazolin
• Vancomycin
• Linezolid

If your child’s doctor prescribes antibiotics, be sure the child takes the full course of treatment. In addition to prescribing antibiotics, the doctor will likely want to make sure that your child has no other medical problems.

Visit Urgency

If your child develops a tender, red, warm, enlarging area on the skin, see a doctor as soon as possible. If your child also has fever and chills, or if the area is on the child’s face, you should go to the emergency room.

If your child is currently being treated for a skin infection that has not improved after 2–3 days of antibiotics, return to the child’s doctor.

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is a strain of “staph” bacteria resistant to antibiotics in the penicillin family, which have been the cornerstone of antibiotic therapy for staph and skin infections for decades. CA-MRSA previously infected only small segments of the population, such as health care workers and persons using injection drugs. However, CA-MRSA is now a common cause of skin infections in the general population. While CA-MRSA bacteria are resistant to penicillin and penicillin-related antibiotics, most staph infections with CA-MRSA can be easily treated by health care practitioners using local skin care and commonly available non-penicillin-family antibiotics. Rarely, CA-MRSA can cause the serious skin and soft tissue (deeper) infection cellulitis, which requires intravenous (IV) antibiotics in most people to clear the infection. If you think your child may have a cellulitis, contact his or her doctor immediately.

Trusted Links

• Clinical Information and Differential Diagnosis of Cellulitis

References

Bolognia, Jean L., ed. Dermatology, pp.1123-1124. New York: Mosby, 2003.

Freedberg, Irwin M., ed. Fitzpatrick’s Dermatology in General Medicine. 6^th ed, pp. 1845, 1848, 1883. New York: McGraw-Hill, 2003.