Cellulitis is a common yet potentially dangerous skin infection that affects millions worldwide each year. The condition is characterised by redness, swelling, warmth, and pain, typically on the lower legs, although it can affect any area of the skin. It is caused by bacteria, primarily Streptococcus and Staphylococcus species, which enter the body through a break in the skin, such as a cut, insect bite, or surgical wound.
Historical background
The understanding of cellulitis and its treatment has evolved significantly over the centuries. In ancient medical history, infections as a cause of disease were not yet understood. People suffering from skin infections like cellulitis were often treated with herbal remedies or crude surgical techniques that lacked the benefit of antiseptics or antibiotics.
The term cellulitis itself is relatively modern, first coined in the 19th century. However, early references to skin infections resembling cellulitis can be traced back to the writings of ancient Greek and Roman physicians such as Hippocrates and Galen. They described various skin conditions, though the exact nature of these infections was not understood. Medical practitioners at the time believed these diseases were caused by imbalances in the body’s hormones, a concept rooted in ancient Greek medicine.
During the Middle Ages and Renaissance, infections were still often seen as divine punishments, and medical treatments were largely ineffective. However, during the 17th and 18th centuries, the field of medicine began to make significant advancements. Anatomists such as Andreas Vesalius and William Harvey made crucial discoveries about the human circulatory and lymphatic systems, which helped in understanding how infections might spread within the body.
The true nature of cellulitis as an infectious disease caused by bacteria began to take shape in the 19th century. The development of germ theory by scientists such as Louis Pasteur and Robert Koch, which proposed that microorganisms cause disease, transformed the understanding of infections. By the late 1800s, doctors were able to link cellulitis to specific bacterial pathogens, though effective antibiotic treatment was still a long way off.
Breakthroughs in treatment
The most significant breakthrough in the management of cellulitis occurred in the 20th century with the discovery of antibiotics. Before this, cellulitis was often a life-threatening condition with limited treatment options. In the early 1900s, physicians attempted to treat cellulitis using surgical drainage and antiseptic treatments, but these methods were not always effective in preventing complications such as sepsis, a life-threatening infection of the bloodstream.
The first antibiotic, penicillin, was discovered in 1928 by Alexander Fleming, revolutionising the treatment of bacterial infections. By the 1940s, penicillin became widely available, and its effectiveness against Streptococcus and Staphylococcus infections made it a cornerstone in the treatment of cellulitis. Over the decades, other antibiotics, such as cephalosporins, clindamycin, and vancomycin, have been developed, expanding the arsenal available to doctors for treating cellulitis and other bacterial infections.
Current management of cellulitis
- Antibiotics
The cornerstone of cellulitis treatment is antibiotic therapy. Empirical antibiotic therapy—initiating treatment before identifying the exact causative organism—is usually prescribed when cellulitis is diagnosed. Common first-line antibiotics for cellulitis include oral penicillin, dicloxacillin, or cephalexin for mild cases. For more severe cases, intravenous antibiotics such as ceftriaxone or vancomycin may be administered, particularly if there is concern about MRSA infection.
In severe or complicated cellulitis cases, or when the infection does not improve with initial treatment, doctors may take cultures from the infected area to identify the specific bacteria and adjust the treatment accordingly. For example, MRSA infections may require a different set of antibiotics, such as clindamycin or trimethoprim-sulfamethoxazole.
- Supportive care
In addition to antibiotics, patients with cellulitis may require supportive care, which typically includes:
Elevation of the affected limb to reduce swelling
Warm compresses to relieve pain
Pain management with nonsteroidal anti-inflammatory drugs (NSAIDs) or paracetamol.
- Surgical intervention
In some cases, cellulitis can lead to the formation of abscesses, which may require drainage. Surgical intervention is typically reserved for cases where there is significant pus buildup or when the infection does not respond to antibiotics.
Prevention and Risk Management
Preventing cellulitis involves addressing risk factors such as:
Managing chronic conditions (e.g., diabetes)
Practising good hygiene
Promptly treating cuts, scrapes, or insect bites to reduce the risk of bacterial entry
For individuals with recurrent cellulitis, prophylactic antibiotics may be considered, particularly if the infection is related to chronic skin conditions or lymphatic issues.
