Cellulitis
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Cellulitis, referred to in Polish as inflammation of connective tissue, is an acute bacterial infection involving the dermis and subcutaneous tissue. The disease most commonly develops as a result of a break in skin continuity, which allows microorganisms to penetrate into deeper tissue layers. Cellulitis is characterized by rapid progression of inflammatory changes, local redness, pain, swelling, and increased skin temperature. In more severe cases, the infection can lead to systemic complications, such as bacteremia, phlegmon, or sepsis. The condition requires differentiation from many other dermatological and vascular diseases, as its course can resemble, among others, venous thrombosis, erysipelas, or allergic reactions. Despite the similar sound of the terms cellulitis and cellulite, they are completely different disease entities with different backgrounds, courses, and clinical significance.
Cellulitis - what is connective tissue inflammation
Cellulitis is a bacterial inflammation involving the skin and subcutaneous tissue. It is most commonly caused by group A β-hemolytic streptococci (Streptococcus pyogenes) and Staphylococcus aureus. Infection typically occurs through minor skin injuries, which often go unnoticed by the patient.
The inflammatory process leads to vasodilation, increased vascular permeability, and infiltration of immune system cells. As a result, the following develop:
- extensive erythema,
- painful swelling,
- local warmth of the skin,
- tissue tenderness,
- sometimes blisters or foci of necrosis.
Cellulitis is most commonly located on the lower limbs, especially in individuals with chronic venous insufficiency, lymphedema, or diabetes. However, lesions may also occur on the face, upper limbs, or trunk.
Unlike superficial erysipelas, cellulitis involves deeper layers of the skin and usually has less clearly defined borders. The disease develops dynamically — untreated, it can lead to a significant deterioration of the patient's general condition within a dozen or so hours.
Cellulitis and cellulite - why they are different things
Despite the similarity in nomenclature, cellulitis and cellulite have no pathophysiological connection. Confusing them is a common mistake resulting from imprecise translations and the similar sound of both terms.
Cellulitis is an acute bacterial infection requiring medical diagnosis and often antibiotic therapy. On the other hand, cellulite (gynoid lipodystrophy) is an aesthetic change resulting from disorders in the architecture of adipose tissue and connective tissue.
The most important differences are presented in the table below:
Feature | Cellulitis | Cellulite |
|---|---|---|
Nature of the change | Bacterial infection | Aesthetic change |
Cause | Bacteria | Microcirculation and adipose tissue disorders |
Inflammation | Acute, infectious | Chronic, non-infectious |
Pain | Often severe | Usually no pain |
Fever | Frequent | Does not occur |
Treatment | Antibiotics | Aesthetic therapies and lifestyle |
Health risk | Potentially serious | Mainly a cosmetic problem |
Aesthetic cellulite manifests as the characteristic “orange peel”, most commonly on the thighs, buttocks, and abdomen. It does not cause systemic symptoms or infection.
In clinical practice, the correct distinction between the two concepts is highly important. A patient with cellulitis requires rapid medical evaluation, while cellulite is a problem in the field of aesthetic medicine and cosmetology.
Cellulitis - symptoms
Cellulitis symptoms usually develop rapidly, within a few hours or days. Features of acute inflammation of the skin and subcutaneous tissue predominate.
Most commonly observed are:
- extensive skin redness,
- pain and tenderness of the affected area,
- swelling,
- increased skin warmth,
- feeling of tissue tightness,
- rapid expansion of the affected area.
The erythema in cellulitis usually has poorly defined borders and may spread peripherally. The skin becomes tight, shiny, and painful to the touch. Some patients experience:
- fever,
- chills,
- weakness,
- muscle pain,
- enlargement of local lymph nodes.
In more severe cases, blisters, petechiae, skin necrosis, or symptoms of sepsis may appear. Particularly dangerous is a rapidly progressing soft tissue infection, which may suggest the development of necrotizing fasciitis.
Cellulitis of the lower limbs is sometimes confused with:
- deep vein thrombosis,
- chronic venous insufficiency,
- contact dermatitis,
- gout,
- drug reactions.
Therefore, diagnosis requires clinical evaluation and — in selected cases — laboratory and imaging tests.
Cellulitis - causes
The direct cause of cellulitis is a bacterial infection that develops after the disruption of the skin's protective barrier. Even minor damage to the epidermis can be a portal of entry for infection.
The most common predisposing factors include:
- cuts and abrasions,
- insect bites,
- skin cracks in the course of athlete's foot,
- chronic ulcers,
- postoperative wounds,
- chronic lymphedema,
- venous insufficiency,
- diabetes,
- obesity,
- immunosuppression.
An important risk factor is also the impairment of microcirculation and the disruption of lymphatic drainage. Lymphedema promotes bacterial proliferation and hinders an effective tissue immune response.
Among the most common microorganisms responsible for cellulitis are:
- Streptococcus pyogenes,
- Staphylococcus aureus,
- MRSA strains (methicillin-resistant Staphylococcus aureus),
- less commonly Gram-negative and anaerobic bacteria.
In patients with diabetes, after water-related injuries, or after exposure to an aquatic environment, the spectrum of pathogens can be broader and include more aggressive bacteria.
Recurrent cellulitis often indicates unrecognized lymphatic system disorders, chronic vascular diseases, or improperly treated skin infections.
Cellulitis - when it requires medical treatment
Cellulitis always requires medical evaluation, as untreated infection can lead to severe local and systemic complications. In most cases, it is necessary to initiate targeted antibiotic therapy against the most common skin bacteria.
Particularly urgent medical consultation is necessary when there are:
- rapidly spreading erythema,
- high fever,
- severe pain,
- shortness of breath or impaired consciousness,
- blisters and skin necrosis,
- symptoms of dehydration,
- significant limb swelling,
- no improvement after 24–48 hours of treatment.
Patients with diabetes, immunosuppression, vascular diseases, or lymphedema belong to the group at increased risk of a severe course of the disease.
Treatment of cellulitis primarily includes:
- oral or intravenous antibiotic therapy,
- anti-inflammatory treatment,
- rest and elevation of the limb,
- control of comorbidities,
- proper skin care.
In complicated cases, hospitalization, surgical treatment, or abscess drainage may be necessary.
In patients with chronic edema and venous insufficiency, supportive treatment that improves microcirculation and reduces lymphatic stasis is also of significant importance.
In medical practice, anti-edema therapy, lymphatic drainage, compression therapy, and treatments supporting the regeneration of skin and soft tissues are used, among others.
