Cohabitants that help to protect our bodies from various forms of infections live on the surface of the skin. One example is the bacterial-fungal relationship. The bacteria control the amount of fungal inhabitants that exist on our skin. Should this balance become "tipped" to favor the fungi, then a fungal infection will occur (tinea pedis is such an example). If the bacteria were to enter into the skin and internal structures of our "protective coat," then cellulitis would occur.

Cellulitis is defined as inflammation of cellular or connective tissue. This condition can be caused by bacterial contaminants that produce an infectious process that requires immediate intervention. The normal bacterial inhabitants on the lower extremity include Staphylococci, Streptococci, Escherichia coli, Pseudomonas aeruginosa, Corynebacterium, and many more. An intact epidermal layer of stratum corneum will not allow entry of these organisms. A breach of this barrier is necessary for infection to occur. The portal of entry into the skin may be through a sweat gland, an abrasion, or laceration. Normally, the white blood cells of the immune system will attack and eliminate these invaders. If the immune system is suppressed or incompetent, however, then infectious cellulitis will occur.

The signs of cellulitis are pain, redness, swelling, and an increased temperature at the site of infection. Occasionally, a "red streak" extending from the site of the infection upward through the lymphatic channels will be present. This is known as lymphangitis, and is also referred to as "blood poisoning." As the bacteria accumulate and reproduce, destruction of skin and connective tissue occurs. The white blood cells respond by trying to "eat" and remove the offending bacteria, thus producing pus. As the pus accumulates, pressure builds, causing increased pain. The accumulated pus is referred to as an abcess, and needs to be lanced or incised to export it from the site. If the infection enters into the bloodstream, the patient becomes septic. He or she may feel weakness, chills, nausea, sweaty, and ill at ease. This condition is life threatening.

Identifying the infectious agent is the first step toward intervention of this process. Blood and/or wound cultures are placed in an incubator for identification and growth to determine which bacteria or fungi is involved. These cultures are also used to determine the most appropriate antibiotic necessary to fight the bacteria. At times, cellulitis may be treated on an outpatient basis. Should there be other medical concerns, such as Diabetes, the patient will be hospitalized for intra venous (IV) antibiotics and close monitoring.

Despite the advances of antibiotics and medical treatment, cellulitis is a grave condition that warrants immediate and intensive medical management. Not only could this be a limb threatening condition, it is also life threatening. To postpone consultation is to take one’s life at great risk.

Dr. Graham has been in private practice in Effingham since 1989 and is on staff at St. Anthony's Memorial Hospital and Effingham Ambulatory Surgical Treatment Center. He is Board Certified by the American Board of Podiatric Surgery and American Board of Podiatric Orthopaedics and Primary Podiatric Medicine. Dr. Graham is a Fellow of the American College of Foot and Ankle Surgeons, the American College of Foot and Ankle Orthopaedics and Medicine, and American Professional Wound Care Association. He is also a member of the American Podiatric Medical Association and the Illinois Podiatric Medical Association.

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