Cellulitis is common enough really, accounting for about 3% of emergency medical consultations,” says Dr Noirin Ni Scannlain, a consultant physician with a special interest in dermatology, based at the Bons Secours Hospital in Tralee.

Anybody can get cellulitis, she says, and you can get it anywhere in the body.

“It’s usually people in the older age group, however, and it usually affects the lower legs, but you can get it in any part of the body – in the arms or face, for example.”

Cellulitis is a bacterial infection and happens when certain types of bacteria like Staphylococcus aureus and Streptococcus get into the body through a crack, cut, wound, leg ulcer or skin conditions like eczema.

“Younger people would get it more if they have a cut, though, or if they have had trauma (injury) to their legs.”

Cellulitis, which affects the inner layers of the skin, is often associated with venous insufficiency, oedema and swelling of the legs.

“Mostly older people I see it in would have varicose veins or they would have lymphedema - that is, problems with their lymph drainage. Lymphedema causes fluid to build up under the skin.”

It isn’t always possible to find the point of entry of the cellulitis infection however, states Dr Ni Scannlain.

“Often we can’t see one. The potential sites of entry would be, say, leg ulcers, or a fungal infection entering between the toes, as well as traumatic wounds.”

But what are the symptoms?

This depends on whether you have mild, moderate or severe cellulitis.

“If it’s mild you may just have redness spreading on a leg with some associated pain or tenderness. If it’s a moderate case you would often complain of fever or flu-like symptoms before the visible onset of cellulitis – the spreading redness and the pain in the leg/limb.

“The worst-case scenario is that the person would become septic with the cellulitis. This can mean low blood pressure and tachycardia (heart irregularities). This is very serious because you can die from sepsis.”

TREATMENT FOR CELLULITIS - ANTIBIOTICS

If the cellulitis is mild a GP will prescribe oral antibiotics, says Dr Ni Scannlain.

“It’s usually flucloxacillin because that would treat the more common organisms causing cellulitis. GPs would usually mark the area of redness on the patient’s leg and tell the patient that if they are not getting better within 24-48 hours to come back.

“If redness is still spreading at that stage, they may admit them to hospital for intravenous antibiotics.”

HOSPITAL TREATMENT

If sent to hospital, blood tests would be done straight away to check if the white blood cell count is elevated.

“We would also do an ESR test (erythrocyte sedimentation rate) and a CRP (C-reactive protein) test. These are markers for inflammation. If you have cellulitis these inflammatory markers would be up. If you had normal results for these the diagnosis of cellulitis is most unlikely.”

Swabs would also be taken of any open wound, cut or ulcer or between toes, to find the source of infection, says Dr Ni Scannlain.

“However, a lot of the time the source of infection or point of entry is not obvious.”

In hospital, patients with cellulitis are assessed every day after being given IV antibiotics. They may appear that they are getting worse initially, says Dr Ni Scannlain.

“That’s because the bacteria may be releasing toxins into the tissues, but after three or four hours the pain and inflammation should have lessened.”

If there is no improvement after a few days, doctors would suspect that some other infection, like MRSA, could be the cause and the antibiotic would be changed accordingly.

“Everybody is checked for MRSA when they come into hospital,” says Dr Ni Scannlain.

RECOVERY RATE IS GOOD

The recovery rate from cellulitis is good.

“You’d use simple measures like pain relief, elevation of the leg in the bed and putting on a soothing paste to reduce the redness. We would check the patient’s circulation also to see if they need compression (socks or bandages).

“After a few days, when the pain has settled, we would put those on to help the healing by doing what’s called ‘improving the venous return’ and also the lymph drainage.

“All those measures are very important and speed up the healing, but the person is usually on antibiotics for five days up to two weeks.”

CAN RECUR

Some people can get cellulitis again.

“That’s usually because of venous insufficiency (a problem with the flow of blood from the veins of the legs back to the heart),” says Dr Ni Scannlain. “Those with diabetes are more prone to infection too – that’s why it is important for them to look after their feet, as a cut could be a portal for entry of bacteria. Being overweight can also be a factor in recurring cellulitis (it can affect lymph flow).”

The lymphatic system is part of the circulatory system and a vital part of the immune system.

“If you have one bout of cellulitis a year that’s okay, but if it’s happening twice a year you would usually be given a prophylactic antibiotic (antibiotic on an ongoing basis) to prevent reoccurrence.”

NOT ALL RED LEGS ARE CELLULITIS

Remember also that not all red legs signal cellulitis.

“Cellulitis is usually unilateral, ie it affects only one leg. If both legs are red it’s not likely to be cellulitis. There could also be swelling for other reasons, so the person could be treated with antibiotics when they are not actually needed. Cellulitis is often misdiagnosed.”

RISK FACTORS FOR CELLULITIS

  • • Injury.
  • • A weakened immune system, eg chemotherapy treatment.
  • • Obesity.
  • • Poor circulation in arms, legs, hands or feet.
  • • Skin disorders like eczema, athlete’s foot, chickenpox and shingles.
  • • Lymphedema (chronic swelling of arms or legs).
  • • Poorly controlled diabetes.
  • • Using illegal, injected drugs.
  • • History of cellulitis.
  • • Some insect bites can also transmit the bacteria that starts a cellulitis infection. Bacteria can also enter through areas of dry, flaky skin.
  • WHEN TO SEE A DOCTOR

    It is important to identify and treat cellulitis early, as it can spread rapidly. See your doctor if you have:

  • • A red, swollen, tender rash, or a rash that’s changing rapidly.
  • • A fever.
  • • Pain in the limb.
  • • Warmth.
  • • Tenderness. CL
  • BUDGET 2018 UPDATE - HEALTH

    Don’t forget that the threshold for the Drugs Payment Scheme (DPS) dropped from €144 to €134 in Budget 2018.

  • • Prescription charges for all medical card holders will drop from €2.50 to €2 also, with the monthly cap dropping from €25 to €20.
  • • Health service funding will rise by €685m to €15.3bn next year.
  • • The Fair Deal or Nursing Home Support Scheme, will see its allocation of funding increase by €9.7m.
  • • Minister of State for Mental Health and Older People Jim Daly said this would be spent on two things – efforts to keep waiting lists down and “to support a new initiative for farm assets and small business”.
  • • The Minister recently proposed a three-year cap on nursing home charges, applicable to farm property.
  • • Fair Deal concerns all farm families, as farmers are currently liable to pay 7.5% of the value of their farm for every year they spend in nursing home care.
  • • While Taoiseach Leo Varadkar has confirmed that the Government was “nearing a resolution” on this issue, it “has not yet been resolved”.
  • • The Attorney General is being consulted about the proposed changes and Minister Jim Daly will then bring these to Cabinet for approval.
  • • The Nursing Home Support Scheme Act 2008 will need to be amended, which will take months – probably to the end of December 2017.
  • • Increases in money allocated for homecare packages were also announced in Budget 2018.
  • NEW BOOKLET – COPING WITH THE

    PRESSURES OF FARMING

    A booklet that will be very helpful for anyone living on a farm, concerned about stress and seeking information about how to get cope with it was launched in September.

    Called Coping with the Pressures of Farming, it was compiled by Teagasc and Mental Health Ireland.

    “A book of this nature is a valuable resource, as the information contained in it is helpful for people at times of crisis and can reduce the sense of loneliness and isolation,” says Finola Colgan of Mental Health Ireland.

    The booklet focuses on recognising stress and ways to combat it.

    As well as all the solid advice and information, it contains mindful reminders like: “Life isn’t waiting for the storm to pass.”

    The publication is available on the Teagasc website https://www.teagasc.ie/publications/2017/coping-with-the-pressures-of-farming.php

    SWEET TAX: IRISH HEART FOUNDATION VIEWS SUGAR TAX AS LANDMARK DAY

    A landmark day in the fight against obesity in Ireland – that’s how the Irish Heart Foundation regards the introduction of a sugar/sweetened drinks levy.

    “It’s the single most important action Government can take to tackle Ireland’s obesity crisis,” it says.

    But what will it mean in the shops?

    A two-litre bottle of Coca Cola or Pepsi will cost 60c more, for example, as a tax of 30c per litre is being imposed if drinks have over 8g of sugar per 100ml.

    Then 20c will be applied to drinks that have between 5-8g of sugar per 100ml.