Is It Cellulitis or Something Else?

Cellulitis is a bacterial inflammation of the skin and appears as an area of red, swollen skin. Pain and rash make it appear like a sore. Confusion arises since several skin conditions like Lymphedema and deep venous thrombosis look similar. They are not the only examples of pseudo-cellulitis. Some other similar skin ailments are venous stasis dermatitis and contact dermatitis. The result often needs to be a correct diagnosis ranging from 30 percent to 90 percent of the cases.

The Crux of the Problem

While diagnosing cellulitis, a medical history is recorded, and a physical examination is done. Next comes the blood tests for bacterial infection. According to a paper published in 2018, cellulitis lacks a reliable diagnosis of microbiology in the laboratory. The problem thus arises of identifying and distinguishing cellulitis from other skin diseases that show similar symptoms.

The Salient Facts About Cellulitis

Staphylococcus or streptococcus bacteria are the usual causes.

  • Oral antibiotics like penicillin or ampicillin treat cellulitis

  • Bacteria enter the skin through an untreated break in the skin.

  • Though found on any body part, cellulitis frequently attacks the feet and legs.

  • Cellulitis spreads to the bloodstream or lymph nodes if treatment is delayed. Such situations may require intravenous antibiotics or pus drainage through surgical methods.

Risk Factors

Cellulitis bacteria enter through skin breaks, besides other health factors

  • Cuts in the skin, tattoos, and insect bites

  • Shingles and chickenpox

  • Athlete’s foot and eczema

  • Injected drugs

  • Obesity

  • Swollen limbs due to edema

  • Swelling resulting from Lymphedema

  • Coronary artery bypass grafting

How to Distinguish Cellulitis From Other skin Conditions?

Cellulitis arises commonly from a bacterial infection. They attack the dermis, fat, and the structure beneath the skin. According to a specialist, the condition in both legs rules out cellulitis. Further, if antibiotics do not cure it, it might be something else, not cellulitis. In such a situation, what could it be?

Cellulitis and Erysipelas

While essentially similar to cellulitis, erysipelas attacks the upper layers of the skin, the epidermis, and the lymph vessels. Group A streptococcus bacteria cause erysipelas through broken skin, blood vessel problems, or lymph system drainage. It occurs anywhere in the body, like on the face, arms, and legs. Along with red patches, blisters or red streaks may appear if the lymph vessels are affected. Fever and chills occur frequently, and pus is rather rare. If lymph vessels undergo severe permanent damage, intense limb swelling occurs. Oral antibiotic treatment is common for cellulitis and erysipelas.

Deep Vein Thrombosis and Cellulitis

Resembling cellulitis, DVT refers to a blood clot in a vein in the interior of the arm, leg, or pelvis. The skin feels hot and swollen, red and painful when touched. If a blood clot breaks down and travels to the lung, pulmonary embolism puts life at risk. A blood thinner like heparin prevents blood clots. Compression on the arm or leg encourages the blood to flow and reduces the chances of complex blood clots. 

Lymphedema and Cellulitis

The swelling that occurs after the lymph system is damaged is called Lymphedema. The fluid does not drain properly. As a result of severe cellulitis, the damaged lymph system could affect the arm or leg. Conversely, Lymphedema presents cellulitis risks with the skin prone to infection. The symptoms of Lymphedema, like red swelling and skin hardness, resemble cellulitis and could be mistaken for it. Both conditions could exist together. Lymphedema treatments include massage, compression garments, bandages, and surgery if needed.

Insect Bites

Red, painful swelling after an insect bite appears like cellulitis. Popular urticaria is another term that refers to hypersensitivity. Children suffer more from flea and mosquito bites since their immune systems are sensitive. Along with severe itching, a red area on the skin may last a week or two. Antihistamines and topical steroids are the usual treatments.

Venous Stasis Dermatitis

Venous stasis dermatitis results from weak blood supply to the lower legs—valves in the veins malfunction. Symptoms copy cellulitis. The red area of the skin swells and becomes tender, and rash occurs, usually on both legs. Itching and infection with open sores form. Blood cells and fluids leak from the vessels into the skin. Ankles may swell with discolored skin. Varicose veins are indicators. Chronic venous insufficiency could lead to conditions known as lipo-dermato-sclerosis or sclerosing panniculitis—red and hard skin results from the infected fat below the skin. Treatments include compression therapy, pain relievers, anti-inflammation drugs, and blood thinners.

Shingles Can Mimic Cellulitis

Also called herpes zoster, shingles originate from the varicella-zoster virus. While appearing initially like a red rash, the pain may last months and years. The eyes may suffer vision loss. Itching and burning accompany pain on the face or body on one side. A rash appears later that forms blisters. While a cure is lacking, a vaccine can control the severity or even prevent it. Get the treatment soon after the symptoms appear.

Dermatitis Resulting from Touch.

Irritation on the skin may follow contact with an object in another condition similar to cellulitis. Swelling and blisters could occur in the skin area that came in contact. It might be an allergic reaction or irritation. Fabric, sunscreens, acids, dyes, and perfumes could be the irritants. Soaps and detergents could also irritate the skin. The reaction could happen a day or two after contact. Topical steroids and lotions could be the treatments. Avoid further contact with the allergen.

Can Cellulitis lead to Complications?

Rarely does one hear of cellulitis leading to serious conditions. Some possibilities are −

  • Osteomyelitis, a bone infection

  • Bacteremia, a blood infection

  • A joint bacterial infection called suppurative arthritis

  • Endocarditis affects the heart and heart valves 

  • Thrombophlebitis, referring to vein swelling due to blood clot 

Prevention Strategies

Following are preventive strategies for healthy, hygienic practices in the absence of vaccines to prevent A strep infections.

Frequently wash hands with soap and water, like after coughs and sneezes. Don’t forget to wash your hands thoroughly before cooking and eating. Liquid sanitizer is very effective in killing germs.

Even minor cuts and bruises must be cleaned with soap and water if they break the skin. Keep the wounds clean and covered with a dry bandage until well healed. If the injury is deep, consult a doctor.

If a skin infection or wound happens, avoid swimming pools and natural water bodies like lakes and rivers.

Several types of bacteria cause cellulitis. Group A Streptococcus (group A strep) commonly infects the lower layers of the skin. Since cellulitis often appears like other skin ailments, health professionals help find the right solution. Avoid delay and consult a doctor immediately after symptoms appear.

Updated on: 07-Apr-2023


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