Key takeaway
Classic signs are localized redness with poorly defined borders, warmth, swelling, pain, and sometimes fever.
What is cellulitis?
It produces a spreading area of redness, warmth, swelling, and tenderness, usually on the lower legs. People with diabetes, edema, venous insufficiency, or immunosuppression are at higher risk. Untreated, it can progress to abscess, sepsis, or necrotizing fasciitis.
Key points to remember
- Classic signs are localized redness with poorly defined borders, warmth, swelling, pain, and sometimes fever.
- The infection commonly follows a cut, insect bite, athlete's foot, ulcer, or surgical wound.
- Lymphangitis may appear as red streaking moving toward regional lymph nodes.
- Diabetes, peripheral vascular disease, lymphedema, and immunosuppression increase risk and severity.
- Systemic spread can cause fever, chills, tachycardia, and progression to sepsis.
Common causes
- Strep, Staph via skin break
- Risk: diabetes, edema, IVDU
Signs & symptoms
- Red, warm, swollen, tender
- Poorly demarcated borders
- Fever, malaise possible
Nursing priorities
- Administer prescribed antibiotics promptly and on schedule; expect IV antibiotics for severe or systemic cases.
- Mark the borders of redness with a skin marker and date it to monitor whether the infection is spreading.
- Elevate the affected extremity and apply warm compresses to reduce edema and promote drainage.
- Assess and document vital signs, pain, and the size and color of the affected area each shift.
- Promote rest, hydration, and analgesia, and monitor blood glucose closely in diabetic patients.
Labs & values
WBC: elevated with infection (normal5,000 to 10,000/mm3)
Blood cultures: identify organism if systemic spread suspected
C-reactive protein: elevated with inflammation
Patient teaching
- Complete the full course of antibiotics even after symptoms improve.
- Keep skin clean, treat cuts and athlete's foot promptly, and moisturize to prevent cracks.
- Elevate the limb, and return if redness spreads, fever develops, or pain worsens.
Red flags: report now
- Rapidly spreading redness, severe pain out of proportion, blistering, crepitus, or dusky skin suggests necrotizing fasciitis; emergency.
- Fever, hypotension, confusion, or tachycardia may indicate sepsis; escalate immediately.
- Red streaking toward the trunk (lymphangitis) signals worsening infection; notify the provider.
- Never massage the inflamed area or apply ice, which can worsen tissue damage.
References
Clinical references for this topic
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