Cellulitis is the most common infectious cause of limb swelling. Cellulitis can occur as a single isolated event or a series of recur-rent events. It is often misdiagnosed, usually as recurrent throm-bophlebitis or chronic venous insufficiency. Cellulitis occurs when an entry point through normal skin barriers allows bacteria to enter and release their toxins in the subcutaneous tissues. The acute onset of swelling, localized redness, and pain is frequently associated with systemic signs of fever, chills, and sweating. The redness may not be uniform and often skips areas. Regional lymph nodes may also be tender and enlarged.
Mild cases of cellulitis can be treated on an outpatient basis with oral antibiotic therapy. If the cellulitis is severe, the patient is hos-pitalized and treated with intravenous antibiotics for at least 7 to 14 days. The key to preventing recurrent episodes of cellulitis lies in adequate antibiotic therapy for the initial event and in identify-ing the site of the bacterial entry. The most commonly overlooked areas are the cracks and fissures that occur in the skin between the toes. Other possible locations are drug use injection sites, contu-sions, abrasions, ulcerations, ingrown toenails, and hangnails.
The patient is instructed to elevate the affected area above heart level and apply warm, moist packs to the site every 2 to 4 hours. Individuals with sensory and circulatory deficits, such as diabetes and paralysis, should use caution when applying warm packs because burns may occur; it is advisable to use a thermometer or have a caregiver ensure that the temperature is not more than lukewarm. Education should focus on preventing a recurrent episode. The patient with peripheral vascular disease or diabetes mellitus should receive education or re-education about skin and foot care.