June 25, 2018
ARTICLE:

Cellulitis

By Dr Megan Yap - Paediatrician

Helloooooo again everyone!

Today, I’m blogging about a very common but potentially very serious problem that affects SKIN.

Those of you who have been following my blog for some time, might remember that when you see “-itis” at the end of a medical word, it means “inflammation of…”

So, for example

  • appendicitis = inflammation of the appendix
  • tonsillitis = inflammation of the tonsils
  • colitis = inflammation of the colon (the large intestine)

In this case with “cellulitis” we are talking about inflammation of the skin caused by a bacterial infection.

Everyone has bacteria that lives on their skin. Because our skin is designed to protect us from harmful things in the environment (as well as waterproofing us and protecting underlying structures like blood vessels, nerves and organs) most of the time, these bacteria don’t cause a problem.  However, when there is damage to the skin – like a cut, scratch, insect bite or a condition like eczema (that causes inflammation), the bacteria can then get into the skin layers and wreak havoc.

The most common types of bacteria that cause cellulitis are Staphylococcus aureus (which you will hear referred to as “staph” or “staph aureus”) and Streptococcus pyogenes (also called “strep” or “strep pyogenes” or a number of other names). Both can cause an aggressive infection, meaning once it starts it can spread quickly and make a child (or adult) very sick.

 

What does CELLULITIS look like?

Cellulitis usually starts as a small area that is red, inflamed and tender (and can occur anywhere on the body). It may also feel warm and appear a bit swollen, there might also be pus or fluid in the skin.  The redness and inflammation will then spread (often very quickly – over a few hours) and your child might start to feel unwell, lose their appetite and spike a temperature (sometimes with chills and sweats) as the infection spreads via the bloodstream (we call this bacteraemia – that is, bacteria in the blood).

Lymph nodes (little nodules of immune system tissue scattered all over the body) in the local area can become swollen and sore as the immune system tries to fight the infection.

 

What do we do about it?

If you think your child has cellulitis, you should go and see your doctor immediately (usually your GP is the best first port-of-call, but an emergency department may be appropriate if your child is unwell and it is after-hours). This is even MORE important in children who have suppressed immune systems (eg if they have an immune system disorder, on chemotherapy etc).

It is a serious infection that can (in rare cases) be fatal if not treated with antibiotics – so the sooner you start, the better.

Tests and monitoring:  A swab might be taken of the infected area and a blood test – especially if the child has a fever and is unwell (this suggests that bacteria is in the blood).  A line is often drawn with a permanent marker around the area of redness to help monitor if the infection is getting better (area of redness becomes smaller) or worse (area of redness continues to get bigger and spread past the drawn line).  It is important not to wash this off because it helps your doctor figure out if the antibiotic is working or not (and if another antibiotic is needed instead). Because of how serious this infection can be, it is likely the doctor will want to see your child every day or every couple of days to make sure they are getting better.

Treatment:

  1. Antibiotics: When kids are systemically unwell, they are often admitted to hospital and treated with antibiotics given directly into a vein through a drip (and then later with oral antibiotics). In milder cases, cellulitis can sometimes be treated just with orally administered antibiotics at home. A response is usually seen within about 2 days, but the medicine might have to be given for 10 days or more.
  2. Elevation: raising the affected area (eg an arm or leg) as high as possible helps reduce swelling (as fluid will drain away better with gravity) and this lessens pain, as can immobilising the area (eg with a splint).
  3. Simple pain relief medicines like paracetamol (eg Panadol) or ibuprofen (eg Nurofen) can also be used to good effect

 

Prevention

Preventing kids from damaging their skin can be difficult, if not impossible. Kids are always falling down and scraping their knees (especially active kids) and it can be hard to control flares of conditions like eczema at times.

Things you CAN do:

  • Use insect repellent/long sleeved clothing if you are going outdoors when you know there will be biting insects
  • Use protective equipment when playing sports (eg elbow/knee pads when skateboarding, helmets, shin guards for soccer, good solid footwear when running/hiking etc)
  • Wash your hands before touching broken skin
  • Clean all cuts and scrapes as soon as they happen with water and soap.
  • Use an antibiotic cream/ointment/liquid (my favourite is Betadine) and cover the wound with a bandage/plaster.
  • If your child has a deep cut or a bite wound (animal or human) – take your child to the doctor as soon as possible for the wound to be washed out properly.

 

As always, I hope this article has been helpful in teaching you a little more about a common but potentially very serious infection.

The most important take-home message is that if you think your child has cellulitis – take them to see a doctor ASAP.

Till next time!!

Stay well!

For more articles from Dr Megan Yap visit her blog – “Dr Megs – Paeds & Feeds” at http://www.kids-health.guru/

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