Cellulitis is a deep skin infection caused by bacteria, typically affecting the dermis and subcutaneous tissue. This infection is common in the lower limbs but can occur anywhere on the body, especially in the presence of wounds, surgical incisions, or skin barrier damage. Early diagnosis and treatment are crucial, as improper management can lead to serious complications.
The presentation of symptoms varies depending on the site of infection, severity, and the patient's immune status. Initial symptoms may resemble general skin inflammation, but as the disease progresses, more distinctive features become apparent. Rapid worsening of symptoms or the presence of systemic signs such as fever or chills warrants immediate medical attention. Understanding the changes in cellulitis symptoms helps in early identification and appropriate treatment.
Early symptoms of cellulitis usually appear within hours to days after infection, primarily localized to the affected skin area. The most common early signs include local redness, warmth, and tenderness. The skin in the infected area may show a uniform erythema, which can rapidly expand over a short period.
On palpation, patients may feel noticeable swelling, and the skin may feel "orange peel" or "rubbery" hardened. Some patients may initially experience mild burning or itching, but these symptoms can quickly worsen. Notably, about 30% of patients have a history of skin injury such as cuts, burns, or surgical wounds prior to infection.
As the infection spreads to deeper tissues, symptoms gradually worsen. Typical signs include the "Four Cardinal Signs" of redness, swelling, heat, and pain, with erythema that may appear bright red or purplish, and edges that are blurred. The skin surface may show slight blistering or serous exudation, and in severe cases, abscess formation can occur.
About 60% of patients exhibit the "Fist Sign" (redness spreading when making a fist), which helps differentiate from other similar skin conditions. The degree of pain may correlate with the depth of infection; deep infections may limit joint movement, such as affecting knee flexion in leg infections.
If untreated, the infection can rapidly worsen within 72 hours. The erythema may expand by 2-3 cm daily, and skin temperature can rise above 40°C. Pain may become severe, affecting daily activities. Approximately 15% of cases develop systemic infection, with symptoms breaching the local area.
The appearance of systemic symptoms indicates that the infection has entered a severe stage. Typical signs include high fever (over 39°C), tachycardia, dizziness, and chills. In immunocompromised patients, neurological symptoms such as confusion may occur, potentially related to sepsis. About 5-10% of cases may develop tissue necrosis, with skin appearing dark purple or black patches.
Initial stage: Blurred erythema edges, skin temperature slightly elevated
Mid-stage: Erythema enlarges beyond 10 cm, with a burning sensation on palpation
Late stage: Skin necrosis may occur, forming ulcers or scabs
Abnormal increase in white blood cell count (usually over 15,000/μL)
Heart rate over 100 beats per minute with rapid breathing
Seek immediate medical care if any of the following symptoms occur:
1. Erythema expands more than 2 cm within 8 hours
2. Accompanied by high fever (≥38.5°C) and chills
3. Presence of altered consciousness or disorientation
4. Skin ulceration or purulent discharge
Special populations such as diabetics, immunosuppressed patients, or recent surgical patients should seek prompt evaluation even with mild symptoms. If symptoms do not improve or worsen after 48 hours of antibiotic therapy, return for reassessment and possible medication adjustment.
Early medical intervention can effectively reduce the risk of complications, including sepsis or deep tissue infection. Physicians may perform physical examinations and order blood tests or imaging studies to assess the extent and severity of the infection.
Bacterial skin infections typically expand rapidly, accompanied by skin warmth, pain, and sometimes fever. If confused with eczema or allergic dermatitis, observe whether symptoms worsen within 24-48 hours or if systemic discomfort occurs. Immediate medical consultation is recommended to rule out infection risk.
Can antibiotics be stopped on my own once symptoms improve?Even if symptoms resolve, the full course of antibiotics must be completed to prevent bacterial resistance or recurrence. If no improvement within 3 days or if high fever and chills occur, return for evaluation and possible medication adjustment.
What daily habits may increase the risk of bacterial skin infection?Chronic wounds such as skin fissures, ulcers, or diabetic foot are at higher risk of bacterial invasion. Maintain skin cleanliness, avoid scratching itchy areas, and properly care for minor wounds by covering with sterile dressings to reduce infection risk.
Can bacterial skin infections be transmitted through contact?General contact (such as touching the patient's skin) is unlikely to transmit directly, but contact with contaminated objects or wound secretions followed by touching damaged skin may increase infection risk. Practice good hygiene and avoid sharing personal items with infected individuals.
How to handle blisters or exudate during treatment?If blisters or yellowish exudate appear, it may indicate worsening infection. Do not puncture blisters; instead, cover with a clean gauze and seek medical advice promptly to evaluate whether treatment adjustments or enhanced care are necessary.
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