Cellulitis

Cellulitis

Cellulitis is a fairly common but potentially serious bacterial skin infection resulting to inflammation manifesting as swelling, pain, warmness and redness of the area involved. ^[1]   Usually an apparent skin breach serves as the portal of entry of the organism, in other cases however, the point of ingress may be minute and there may be no obvious breakages in the skin. ^[2]

Epidemiology

There is no age and gender predilection. However some report increased incidence among elderly patients. ^[2]

Causes

Cellulitis is caused by microscopic organisms often by bacteria called Streptococcus or Staphylococcus. Other bacteria implicated in the disease are H influenzae type B and S pneumonia. ^[2]

People at risk to get the disease are those who have skin breakages or trauma, insect bites or stings, bone infection and peripheral vascular diseases. Foreign bodies such as indwelling catheter and surgical devices can also predispose a person to infection. Likewise, surgery patients, people on immunosuppressant medicines like corticosteroid and diabetic patients are more susceptible to get cellulitis.  ^{[1] [2] [3]}

Signs and Symptoms

A patient may notice that the affected area is tender, warm and red. There is often confusion with another medical condition called erysipelas. In the latter, the border is elevated and with sharp margin or demarcation.

The person with cellulitis may also develop fever, chills, muscle ache, nausea and vomiting. Occasional finding also is swollen lymph nodes adjacent to the area.  ^{[2] [3]}

Diagnosis

Patient history and physical exam are essential to make a diagnosis. Complete blood exam is performed to see signs of infection as marked by blood cell parameters. Culture of the blood can also identify causative organism. ^[3]

Treatment

Many cases are treatable with antibiotics prescribed on an outpatient scheme. Drainage is an important part of treatment especially for those with hastily spreading cellulitis and those with extreme pain. When the infection is severe, the person may need to be admitted to be given intravenous medications. Longer treatment is compulsory for patients with concomitant diseases. Cellulitis responds very well to drugs but it can also lead to complications if not given medical attention right away such as infection of the blood, meningitis and death of tissue.  ^{[2] [3]}

References:

1.      http://www.emedicinehealth.com/cellulitis/article_em.htm

2.      http://emedicine.medscape.com/article/214222-overview#a0156

3.      http://www.nlm.nih.gov/medlineplus/ency/article/000855.htm

Efficacy of Alternative and Other Treatments According to GRADE* Ranking:

Thuja (Eastern White Cedar, Thuja Occidentalis) [1, 20, 21, 22]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present. Little is known about the full effects of Thuja, so it is not recommended for medicinal use. Thuja can be poisonous if ingested in large amounts.

Recommendation: no recommendation (There is insufficient evidence to support claims that Thuja helps to treat cellulitis)

Grade of Evidence: very low quality of evidence

Tea Tree Oil [1, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19]:

Please note, this management does NOT treat the condition itself. It is proposed only as a weak supportive symptomatic support, and even then, has insufficient evidence to back up this claim at present. WARNING: Tea Tree Oil is not recommended for children, pregnant women or mothers that are breastfeeding. Also, Tea tree oil should never be taken internally. Should only be used over skin, inhaled with a vaporizer, or mixed with water as a mouthwash.)

Recommendation: No recommendation (Research on the effectiveness of tea tree oil in treating cellulitis has yielded mixed results.)

Grade of Evidence: low quality of evidence

Licorice (Glcyrhiz Gaba) [1, 6, 7, 8, 9]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present. Licorice has been shown to have potentially harmful side effects in people with high blood pressure, liver or kidney diseases)

Recommendation: No recommendation (There is insufficient evidence to support claims that licorice helps in the treatment of cellulitis. More research is needed)

Grade of Evidence: low quality of evidence

Cloves (Caryophyllum Aromaticum, Eugenia Caryophyllata) [1, 2, 3, 4, 5]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: weakly in favor  (evidence suggests that cloves can be local anaesthetics and may be effective at slowing bacterial infections. They therefore may be helpful in treating the symptoms of cellulitis, but more research is needed)

Grade of Evidence: low quality of evidence

Arnica Root (Arnica Montana):

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: no recommendation (available evidence shows that Arnica is in no way helpful in the treatment of cellulitis)

Grade of Evidence: moderate quality of evidence

Hyperbaric Oxygen Therapy (HBOT):

Recommendation: strongly against (available evidence shows that HBOT is in no way useful in treating cellulitis, and can have harmful effects. NOT RECOMENDED)

Grade of Evidence: low quality of evidence

Heat Therapy

Recommendation: weakly against (there is scant evidence that heat therapy may help speed healing in skin infections, however more research is needed, and there are possible harmful effects to heat therapy being used without supervision by a qualified physician)

Grade of Evidence: low quality of evidence

* www.gradeworkinggroup.org

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