EDP column by Dr Ketan Dhatariya

“My legs have been very red and painful for several months and my local pharmacist tells me that I have ‘cellulitis’. What is cellulitis?"

When you are well, you have several barriers to stop the ‘outside world’ getting ‘inside’ your body. The first barrier is your skin. The skin is made up of several different layers of cells that start at the bottom and work their way out. As the skin cells come to the surface, the die and are eventually flake off. Most of the stuff we call ‘household dust’ is actually human skin. The surface of the skin is covered in billions of bacteria, but the skin is an effective barrier to ensure they stay where they are.

The skin usually forms a continuous, however, if the skin is broken, e.g. by a cut or a wound, the bugs that usually stay on the outside of the skin, can get in. The immune system is present to help keep these bug’s at bay, and to keep their effect to a minimum. Athlete’s foot also predisposes to the development of cellulitis as the fungus breaks the skin. However, there are some conditions, such as diabetes, in whom the immune system may not work quite as well as others who are otherwise healthy. Another reason why the immune may not work as well is with normal ageing. In addition, with ageing, the skin may get thinner and break more easily. If you have a break in the skin, then the bugs will get in and if your immune system is not as active as it once was, then you are at risk of developing cellulitis that may be difficult to treat.

Common places to get cellulitis are the legs and the face. An insect bite may also lead to cellulitis as the bite will get through the protective barrier of the skin and introduce bacteria into the lower layers. Often these areas may become hot, red, painful, and swollen. This is due to the increase in blood supply to get the substances that heal the wound to the site of injury. The infection may spread rapidly or may stay in the same place for a long time.

Antibiotics are a way of speeding up recovery, and topical solutions to help keep the skin clean, such as potassium permanganate may also help in some circumstances. In more serious cases, hospital admission is necessary to give intravenous antibiotics. However, as always, when in any doubt, go to your GP or pharmacist before you start any treatment.

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