What is cellulitis ear infection? How is perichondritis different from simple cellulitis? What are the red flags and when should the ENT registrar be involved? How to assess and recognize perichondritis? What is the immediate and overnight management? Find the answers to these questions and more in this comprehensive guide.

Understanding Cellulitis Ear Infection and Perichondritis

Cellulitis ear infection, also known as pinna cellulitis, and perichondritis are potentially serious conditions that require prompt medical attention. Pinna cellulitis can occur as a complication of acute otitis externa, eczema, psoriasis, or an insect bite. Perichondritis, on the other hand, is usually a result of penetrating trauma, including ear piercing.

Red Flags and Importance of Prompt Treatment

If left untreated, pinna perichondritis can lead to the formation of an abscess, which can lift the perichondrial layer off the cartilage and result in necrosis and a cauliflower deformity. Perichondritis may also progress to a systemic infection or a serious soft tissue infection, such as necrotizing fasciitis.

When to Involve the ENT Registrar

Patients with pinna perichondritis should be seen by the ENT registrar as soon as practical, either during the post-take round or in an emergency clinic. For patients with a definite abscess or necrosis, while overnight surgical drainage or debridement may not be practical, discussion with the ENT registrar is advisable. Patients with a pinna abscess, sepsis, or neurological signs should be discussed with the ENT registrar immediately.

Who Should Be Admitted

Patients with a pinna abscess or tissue necrosis, an ear infection and deterioration in central neurological status, those who have failed to respond to oral antibiotic treatment, and immune-suppressed or compromised patients (e.g., uncontrolled diabetes mellitus, HIV/AIDS, recent chemotherapy) should be admitted for further management.

Assessment and Recognition of Perichondritis

When assessing a patient with suspected perichondritis, it’s important to take a focused history, including any recent history of significant trauma, such as piercing, acupuncture, burn, pinna hematoma, or laceration. Comorbidities like diabetes mellitus may also predispose patients to perichondritis. On examination, pinna perichondritis typically presents with infection of the cartilaginous pinna, sparing the lobule (ear lobe), whereas cellulitis does not spare the lobule.

Immediate and Overnight Management

Patients with no evidence of abscess formation should undergo microbiological swabs of the pinna, any otitis externa, and for MRSA status. A trial with systemic and topical antibiotics would be a good starting point, targeting the most common causative organisms (Pseudomonas aeruginosa in perichondritis, Staphylococcus aureus or other skin organisms in cellulitis). Patients with abscess or tissue necrosis will require additional measures, including discussion with the ENT registrar, nil by mouth pending a decision to operate, and IV access with appropriate lab tests.

Further Management

Patients who respond well to oral or intravenous antibiotics should be reviewed as outpatients. Any piercing should not be replaced until a reasonable interval has passed and there is no gross deformity. Patients with an abscess that requires drainage will need regular wound re-packing/dressing as outpatients before healing by secondary intention.

Cellulitis ear infection and perichondritis are serious conditions that require prompt recognition and management. By understanding the key differences, red flags, and appropriate treatment approaches, healthcare professionals can ensure timely and effective care for patients with these conditions.

What are the main differences between cellulitis ear infection and perichondritis? Cellulitis ear infection, or pinna cellulitis, typically involves the skin and soft tissues of the ear, while perichondritis specifically affects the cartilaginous pinna, sparing the ear lobe. The causative organisms are also usually different, with Pseudomonas aeruginosa more common in perichondritis and Staphylococcus aureus or other skin organisms more common in cellulitis.

Why is it important to differentiate between cellulitis and perichondritis? Early recognition and appropriate management of perichondritis is crucial, as it can lead to serious complications like abscess formation, tissue necrosis, and even systemic infection if left untreated. Perichondritis requires prompt involvement of the ENT registrar and may necessitate surgical intervention, whereas cellulitis may respond to a trial of oral or topical antibiotics.

What are the key signs and symptoms that can help distinguish cellulitis from perichondritis? The main distinguishing feature is the involvement of the cartilaginous pinna, with perichondritis typically presenting with painful erythema and induration of the pinna and loss of contours, while the ear lobe remains spared. In contrast, cellulitis will not spare the ear lobe.

How should patients with suspected perichondritis be managed initially? Patients with no evidence of abscess formation should undergo microbiological swabs and a trial of systemic and topical antibiotics, targeting the most common causative organisms. Patients with an abscess or tissue necrosis will require additional measures, such as discussion with the ENT registrar, nil by mouth pending a decision to operate, and intravenous access with appropriate laboratory tests.

What are the long-term considerations for patients with perichondritis? Patients who respond well to treatment should be reviewed as outpatients, and any piercings should not be replaced until a reasonable interval has passed and there is no gross deformity. Patients with an abscess that requires drainage will need regular wound re-packing/dressing as outpatients before healing by secondary intention.

Why is it important to be cautious with certain patient presentations? Patients presenting with five or more days of symptoms of pinna cellulitis or those with recent penetrating trauma and symptoms of pinna perichondritis should be assessed and managed with extra caution, as they may be at higher risk of complications.

How can healthcare professionals ensure prompt and appropriate management of perichondritis? Early recognition of the condition, involvement of the ENT registrar, and adherence to established treatment protocols are key to preventing serious complications and optimizing patient outcomes. Maintaining a high index of suspicion, particularly in cases with risk factors or atypical presentations, can also help healthcare professionals provide timely and effective care.

Pinna perichondritis or cellulitis — entsho.com

RED FLAGS

WHY IS THIS IMPORTANT?

Pinna perichondritis or cellulitis are potentially serious conditions.

Pinna cellulitis can occur as a complication of acute otitis externa, a complication of eczema or psoriasis, or from an insect bite. 

Pinna perichondritis is usually a result of penetrating trauma, including ear piercing. Left untreated, an abscess may form, lifting the perichondrial layer off the cartilage and resulting in necrosis and a cauliflower deformity. Pinna perichondritis may also progress to systemic infection or a serious soft tissue infection including necrotising fasciitis. 

WHEN TO INVOLVE THE ENT REGISTRAR

Soon: Patients with pinna perichondritis should be seen by the registrar as soon as practical (post take round or emergency clinic, as applicable). For patients with a definite abscess or necrosis, while overnight surgical drainage or debridement may not be practical, discussion is advisable.

Immediately: Discuss all patients with pinna abscess, sepsis and neurological signs.

WHO TO ADMIT

• Patients with a pinna abscess or tissue necrosis

• Patients with an ear infection and deterioration in central neurological status

• Patients who have failed to respond to oral antibiotic treatment

• Immune suppressed or compromised patients eg uncontrolled diabetes mellitus, HIV AIDS, recent chemotherapy

• Be cautious with patients presenting newly with five or more days of symptoms of pinna cellulitis and those with recent penetrating trauma and symptoms of pinna perichondritis

ASSESSMENT AND RECOGNITION

HISTORY

Take a focused history, including recent history of any significant trauma: piercing; acupuncture; burn; pinna haematoma; laceration and so on.

Comorbidities such as diabetes mellitus may predispose patients to perichrondritis. It is also important to take note of previous antibiotics and if there is a history of recurrent otitis externa.

EXAMINATION

Pinna perichondritis typically presents with infection of the cartilaginous pinna and sparing of the lobule (ear lobe), whereas cellulitis does not spare the lobule. This is important because the causative organisms are usually different (see below).

The main question is then, ‘Is there any abscess or necrosis?’ so examine the ear carefully for:

• Painful erythema and induration of the pinna with loss of contours

• Localised abscess formation

• Necrosis of soft tissue

• Primary otitis externa – perform otoscopy

• Clinical hearing deficit

• Spreading cellulitis of the face or scalp – please mark this

• Any signs of trauma or any wounds

You must perform a lower cranial nerve examination and other general or neurological examinations as indicated.

Take note of any indwelling piercings and remove all of them, especially any in or near areas of perichondritis, cellulitis or abscess. 

IMPORTANT: If the symptoms and signs are mild and involve both pinnas and the nose, you may be dealing with a relapsing POLYchondritis, which is an autoimmune condition affecting cartilage and not an infective condition.

IMMEDIATE AND OVERNIGHT MANAGEMENT

Patients with no evidence of abscess formation:

• Microbiological swabs of the pinna, of any otitis externa and for MRSA status

• A trial with systemic and topical antibiotics would be a good starting point

  • The commonest causative organism in pinna perichondritis is Pseudomonas aeruginosa; in pinna cellulitis it can be Staphylococcus aureus or other skin organisms

  • If you want to use a fluoroquiniolone to treat a Pseudomonal infection, seek a microbiological opinion or consult local guidelines: systemic fluoroquinolone usage is associated with a high rate of secondary Clostridium difficile; alternatives include co-amoxiclav, tazobactam/piperacillin or clindamycin

  • Oral fluoroquinolones and macrolides have good oral bio-availability so IV therapy is not indicated unless the patient is vomiting or drowsy

  • Topical fusidic acid cream may help treat staphyloccocal infection

• Good analgesia

• If applicable, control of blood sugars or reverse barrier nursing

• If there is sepsis, then blood cultures should be taken: remember your Sepsis Six

Patients with abscess or tissue necrosis:

• All of the above

• Discussion with the ENT Registrar

• Nil by mouth pending a decision to operate

• IV access, FBC, U&E, CRP, Coag/INR

Unless there are concerns about cranial complications such as brain abscess, CT scanning is not indicated.  

FURTHER MANAGEMENT

Patients who respond well to oral or intravenous antibiotics should be reviewed as outpatients. Any piercing should not be replaced until a reasonable interval has passed and there is no gross deformity. Patients should be advised that cartilaginous piercings are high risk for severe infections. 

Patients who require drainage of an abscess will need to have their wound re-packed/dressed regularly as outpatients before healing by secondary intention. Cosmetic deformities may occur or remain after surgery. Sometimes, a plastic surgery referral may be required to consider reconstruction of severe deformities of the pinna.

REFERENCES

Perichondritis of the auricle: analysis of 114 cases     

Transcartilaginous ear piercing and infectious complications: A systematic review and critical analysis of outcomes

Page last reviewed: 15 December 2019

Pinna Perichondritis – StatPearls – NCBI Bookshelf

Continuing Education Activity

Perichondritis of the pinna is a potentially serious infection that can lead to permanent deformity of the external ear. In addition, if poorly managed, it can progress to a severe soft tissue or systemic infection. This activity outlines the evaluation and management of pinna perichondritis and explains the role of the interprofessional team in managing patients with this condition.

Objectives:

• Describe how pinna perichondritis can lead to ear deformity.

• Review the signs and symptoms of pinna perichondritis.

• Summarize the treatment for pinna perichondritis with consideration of the causal organisms.

• Identify how an interprofessional team can work together to identify and treat pinna perichondritis.

Access free multiple choice questions on this topic.

Introduction

Perichondritis of the pinna is inflammation of the perichondrial layer surrounding the cartilage of the ear. Penetrating trauma to the ear, such as transcartilagenous high ear piercings, is the commonest cause of perichondritis. Non-medical practitioners carry out the majority of ear piercings, and if sterile conditions are not maintained, this can precipitate infection.

If the infection is neglected, an abscess can form, which causes perichondrial elevation from the cartilage, resulting in devascularisation. This will cause necrosis and alteration to the shape of the pinna. If blood collects in this space, it may organize and form hard scar tissue, giving the appearance of a cauliflower ear. It can also progress to a serious soft tissue or systemic infection if left untreated.

Etiology

There are several causes of perichondritis of the pinna. However, the most identified cause in the literature is penetrating trauma to the cartilaginous pinna.[1]][2] A rise in perichondritis cases in the past decade has been linked by some authors to the increasing amount of transcartilagenous ear piercing, which, compared to lobule piercings, carry a greater risk of infection or abscess formation.[3]

Less common causes include untreated middle or external ear infections spreading to the pinna and cartilage, iatrogenic (post-surgery), immunosuppression, and minor trauma such as scratching the ear. There is also a significant proportion of patients who have no identifiable cause.[1]

Perichondritis can also be caused by herpes zoster infection, perhaps from vesicles enabling a route of entry for bacteria to invade.[4]

The commonest causative organism of perichondritis of the pinna is pseudomonas aeruginosa which seems to have a predilection for damaged cartilage. Other causative organisms include Staphylococcus aureus and Escherichia coli.[1][3][4]

Epidemiology

Perichondritis of the pinna is not a common condition. Its incidence is unknown; however, it has been reported that cases rose by double between 1990 to 1998 in England. This increase was attributed to the increase in ear piercings among adolescents.[5]

Pathophysiology

The perichondrium is a layer of dense connective tissue that surrounds the cartilage. It facilitates the growth and repair of the cartilage. Trauma can cause microfractures of the cartilage and causes the perichondrial layer to strip off the cartilage, resulting in devascularisation and necrosis. [5]

The scanty blood supply to this area makes it especially susceptible to infection despite even aseptic techniques of ear piercing.[6] This necrosis leads to cosmetic deformity. If blood collects in the space created by the elevated cartilage, it will collect and harden to form a permanent structural deformity, colloquially known as the ‘cauliflower ear.’ If left untreated, perichondritis can lead to infection of the surrounding soft tissue, causing pinna cellulitis or abscess formation.

Histopathology

A histological study was performed by Van Wijk et al., which set out to measure the extent of cartilage damage by ear-piercing techniques on cadavers. They showed that piercing caused the perichondrium to tear off the cartilage, creating a detachment pocket, which could enable the formation of an abscess.[7]

History and Physical

Perichondritis of the pinna is a clinical diagnosis; therefore, a focused history and thorough physical examination are essential.

The history should include any recent significant trauma to the lateral face and ear, including piercing, acupuncture, grazes, burns, lacerations, or pinna hematoma. Clinicians should ask about relevant symptoms such as hearing loss, otorrhea, or cranial nerve abnormalities, which would point to a different diagnosis. Particular attention should be paid to comorbidities in the patient’s past medical history, such as diabetes or immunosuppression, that could increase the likelihood of infections.

Physical examination should consist of a comprehensive ear exam with an inspection, palpation, and otoscopy. Patients will typically present with an erythematous, swollen, hot, painful pinna. In perichondritis, the lobule is often spared, helping to differentiate it from pinna cellulitis.[8][9]

This is important as there are different causative organisms for both, and if pinna cellulitis is present, it would be prudent to mark the affected area. There may be a small abscess present or necrosis of the soft tissue. Palpation will reveal a tender pinna. To complete the examination mastoid process, pre and post-auricular regions should be examined for tenderness. A cranial nerve exam and neck swelling exam should be performed as indicated.

Systemic symptoms such as pyrexia or extension of erythema beyond the pinna suggest that the infection has spread beyond the external ear.

Careful otoscopy should be performed, with the unaffected ear examined first. The clinician should look for any debris or discharge, erythema, or swelling in the external ear canal, which would point to perichondritis caused by otitis externa, which is primarily treated with suction clearance and topical antibiotics. The tympanic membrane should also be assessed for an air-fluid level or perforation.

Lastly, if a patient presents with inflammation of both pinnae, nose, and joints, or tracheobronchial abnormalities, consider a diagnosis of relapsing polychondritis, which is an autoimmune condition and is primarily treated with oral steroids. [10]

Evaluation

Routine blood tests are not usually indicated in simple pinna perichondritis. However, if there is an extended area of swelling, an abscess, or necrosis, blood tests should be obtained, including full blood count, urea and electrolytes, c-reactive protein, blood cultures, and coagulation screen. This should also form part of a sepsis screen in an unstable patient.

Microbiology swabs should be taken of the affected area and any discharge present.

Imaging is not indicated unless there is a suspicion of intracranial pathologies, such as an abscess.

Treatment / Management

Antibiotic therapy is the mainstay of treatment for pinna perichondritis. The management pathway is dependent on the presence or absence of abscess formation.

If an abscess is present, the patient should be admitted to the hospital for definitive treatment. This consists of admission blood tests and preparing the patient for theatre, considering an incision and drainage of the pinna to remove the collection of pus or hematoma.

If there is no abscess present, the patient should be started on both oral and topical antibiotics. Considering the casual organisms, clinicians should initiate an antibiotic regime that provides adequate coverage for both pseudomonas aeruginosa and staphylococcus aureus. Clinicians should follow their local antimicrobial prescribing guidelines and seek microbiology advice if unsure.

Fluoroquinolone antibiotics are readily available in both oral and topical forms and provide excellent staphylococcal and pseudomonal cover. However, historically they are avoided in the pediatric population due to side effects of arthralgias and tendon rupture.[2] A meta-analysis of fluoroquinolone use in children showed a low incidence of musculoskeletal side effects, which all resolved on withdrawal of the medication, and no studies have shown growth disturbances associated with its use. This suggests that a short course for a pediatric patient is safe to use.[11]

Fluoroquinolone antibiotics are well absorbed with good bioavailability, eliminating the need to use intravenous antibiotics unless the patient is nil by mouth or concerned about an unsafe swallow. However, clinicians should not forget this is a painful condition, and therefore adequate analgesia should be prescribed alongside treatment.

Differential Diagnosis

Clinicians should be aware of a range of pathologies that can cause a painful, inflamed external ear. When examining children, it is especially important to perform otoscopy to rule out complicated otitis media, as they will not be able to communicate their symptoms as effectively as adults.

Differential diagnoses that should be considered include:

• Pinna cellulitis

• Otitis externa

• Otitis media

• Dermatological conditions affecting the ear, i.e., eczema or psoriasis.

• Malignant otitis media

• Relapsing polychondritis

Prognosis

With prompt diagnosis and treatment with antibiotic therapy, the symptoms should settle in 2 or 3 days. However, symptoms such as pain can persist for up to a month.

Cosmetic deformity depends on the severity of the infection and the damage to the underlying cartilage. [1] This is especially important in perichondritis with abscess formation, which requires surgical treatment, and cartilage may be damaged. Patients who have an incision and drainage will require packing and re-dressing the wound to allow it to heal without recollection.

Complications

If left untreated, perichondritis will lead to cartilage necrosis and result in minor cosmetic deformity or ‘cauliflower ear.’

The infection can also spread beyond the pinna and cause the patient to become systemically unwell, needing intravenous antibiotics and hospital admission.

Deterrence and Patient Education

Patients should be aware of the increased risk of high ear piercings causing pinna perichondritis, as opposed to simple lobule piercing. If they develop a painful, swollen, and red external ear, they should seek professional health advice. Delaying presentation could cause permanent deformity of the ear.

Enhancing Healthcare Team Outcomes

Pinna perichondritis is an infection of the perichondral lining of the ear cartilage. It is primarily caused by pseudomonas aeruginosa and staphylococcus aureus. Patients will present with an erythematous, swollen, hot external ear, with sparing of the lobule. There may also be a collection of pus present. It is commonly caused by minor trauma, such as ear piercings through the cartilaginous pinna, but other causes must be considered.

Prompt diagnosis is needed so the appropriate antibiotic therapy can be started. Whilst this is primarily an ear, nose, and throat (ENT) condition, uncomplicated cases such as those without a collection can be managed in a primary care setting with oral antibiotic therapy. If there is any concern regarding antibiotic therapy, the ENT surgeons, infectious disease, and pharmacists should be consulted, and they will be able to advise what the local protocol for antibiotic therapy is in both adult and pediatric populations of patients. 

If the medical practitioner has identified a complicated pinna perichondritis with the presence of an abscess and necrosis, a referral to the ENT surgeons should be made as management involves surgical incision and drainage or debridement of the pinna. If there is a late presentation of this condition, the patient should be counseled on the possibility of residual cosmetic deformity. 

A delay in treatment or misdiagnosis can cause permanent damage, so it is important to manage this condition quickly and effectively. It is important to distinguish pinna perichondritis from relapsing polychondritis as both have different management plans.

Review Questions

• Access free multiple choice questions on this topic.

• Comment on this article.

References

1.

Prasad HK, Sreedharan S, Prasad HS, Meyyappan MH, Harsha KS. Perichondritis of the auricle and its management. J Laryngol Otol. 2007 Jun;121(6):530-4. [PubMed: 17319983]

2.

Sosin M, Weissler JM, Pulcrano M, Rodriguez ED. Transcartilaginous ear piercing and infectious complications: a systematic review and critical analysis of outcomes. Laryngoscope. 2015 Aug;125(8):1827-34. [PubMed: 25825232]

3.

Liu ZW, Chokkalingam P. Piercing associated perichondritis of the pinna: are we treating it correctly? J Laryngol Otol. 2013 May;127(5):505-8. [PubMed: 23442437]

4.

Davidi E, Paz A, Duchman H, Luntz M, Potasman I. Perichondritis of the auricle: analysis of 114 cases. Isr Med Assoc J. 2011 Jan;13(1):21-4. [PubMed: 21446231]

5.

Hanif J, Frosh A, Marnane C, Ghufoor K, Rivron R, Sandhu G. Lesson of the week: “High” ear piercing and the rising incidence of perichondritis of the pinna. BMJ. 2001 Apr 14;322(7291):906-7. [PMC free article: PMC1120071] [PubMed: 11302908]

6.

Wu J, Collins NP, Wilson SF. Perils of pinna piercing and pseudomonas perichondritis. Aust Fam Physician. 2003 Jul;32(7):516-7. [PubMed: 12901204]

7.

van Wijk MP, Kummer JA, Kon M. Ear piercing techniques and their effect on cartilage, a histologic study. J Plast Reconstr Aesthet Surg. 2008;61 Suppl 1:S104-9. [PubMed: 17684004]

8.

Staley R, Fitzgibbon JJ, Anderson C. Auricular infections caused by high ear piercing in adolescents. Pediatrics. 1997 Apr;99(4):610-1. [PubMed: 9093311]

9.

Bress E, Cohn JE. Perichondritis: inspect the lobule. Int J Emerg Med. 2020 Oct 28;13(1):51. [PMC free article: PMC7594288] [PubMed: 33115411]

10.

Hirayama K, Iwanaga N, Izumi Y, Yoshimura S, Kurohama K, Yamashita M, Takahata T, Oku R, Ito M, Kawakami A, Migita K. A Case of Relapsing Polychondritis Initiating with Unexplained Fever. Case Rep Med. 2016;2016:9462489. [PMC free article: PMC4769741] [PubMed: 26981127]

11.

Adefurin A, Sammons H, Jacqz-Aigrain E, Choonara I. Ciprofloxacin safety in paediatrics: a systematic review. Arch Dis Child. 2011 Sep;96(9):874-80. [PMC free article: PMC3155117] [PubMed: 21785119]

Disclosure: Najeed Khan declares no relevant financial relationships with ineligible companies.

Disclosure: Nina Cunning declares no relevant financial relationships with ineligible companies.

Infectious cellulitis – causes, symptoms, diagnosis and treatment

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Cellulite: causes, symptoms, diagnosis and treatment.

Definition

Infectious cellulitis, or, as it is also called, streptococcal cellulitis, acute indurative cellulitis, bacterial cellulitis, is a deep inflammatory lesion of the skin and subcutaneous tissue, accompanied by induration, redness, swelling, pain.

Cosmetologists understand cellulite not as an inflammatory process, but as a lobular structure of subcutaneous fatty tissue, uneven deposition of subcutaneous fat, which manifests itself outwardly as uneven skin. It is necessary to clearly separate the dermatological nosology “cellulite” and the cosmetic problem “false cellulite”, or gynoid lipodystrophy.

Cellulite disease has nothing to do with an aesthetic defect, which is commonly referred to as “orange peel”.

Causes of cellulite

Cellulitis is usually caused by bacterial flora – group A streptococci, Staphylococcus aureus, pneumococcus. The process is associated with an open wound surface or skin abscess. In some cases (with diabetic ulcers of the lower extremities, severe tissue ischemia, after animal bites), other microorganisms, mainly aerobic gram-negative bacteria, can become the cause of cellulite. Yeast-like fungi of the genus 9 are considered rare causative agents of cellulite. 0039 Candida , pathogenic fungi, parasites, viruses. There is an allergic variant of cellulitis – eosinophilic cellulitis (Wells syndrome).

Cellulitis on intact skin is called “erysipelas”. Erysipelas is an acute form of cellulitis that occurs with the involvement of the lymphatic tissue in the inflammatory process, where the pathogen multiplies. Erysipelas affects the upper layers of the skin, while cellulite extends to deeper tissues. However, it is often quite difficult to draw a clear line between them, so they use the single term “cellulite”.

About half of patients with cellulite experience its recurrence. The recurrent course of the disease is often associated with pathologies of the venous and lymphatic systems. As a rule, traumatic or surgical interventions cause the first manifestations of cellulite. Cellulitis of the lower extremities usually occurs in older patients against the background of hypostatic phenomena (varicose veins, lymphostasis, etc.), as well as fungal diseases of the feet due to a violation of the barrier function of the skin.

Cellulite develops in places of skin damage as a result of microtraumas, cracks, cuts, burns, punctures, animal and insect bites, trophic ulcers, and edema of any etiology. The most susceptible to recurrent infection are patients with diabetes mellitus, obesity, liver cirrhosis, renal failure, as well as cancer patients and people who have foci of chronic infection or have reduced immunity.

Most often, cellulite is localized on the legs, face, auricles, although it can also affect other parts of the body.

Disease classification

The following clinical variants of cellulite are distinguished:

• erythematous,
• erythematous hemorrhagic,
• erythematous-vesicular,
• erythematous-vesicular-hemorrhagic,
• erythematous-bullous-hemorrhagic.

Cellulite symptoms

The disease begins acutely, usually within 1-3 days after exposure to a provoking factor. The clinical picture of cellulite is characterized by diffuse redness with blurry edges, the area of ​​inflammation is hot and painful on palpation. The lesions quickly increase in size, becoming plaque-like and edematous. Sometimes red stripes are noted – this is due to the transition of the infection to the lymphatic vessels, which become inflamed, causing hyperemia along the vessels. Slower and less acute cellulitis develops around ulcers.

A feeling of fullness, burning, pain appears in the area of ​​inflammation. Redness in a few hours turns into a bright erythema with clear uneven contours, swelling and infiltration of the skin are observed. Blisters often appear with hemorrhagic contents.

In severe cases (less than a third of patients), fever up to 38-40 ° C, chills, tachycardia, lowering blood pressure, headache, general malaise are possible.

Cellulite diagnostics

The diagnosis of cellulite is based on a visual assessment of the clinical manifestations and laboratory confirmation. The main diagnostic measures include:

• complete blood count;

Clinical blood test: general analysis, leukoformula, ESR (with microscopy of a blood smear in the presence of pathological changes)

Synonyms: Complete blood count, UAC. Full blood count, FBC, Complete blood count (CBC) with differential white blood cell count (CBC with diff), Hemogram.
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General urinalysis (Urine analysis with sediment microscopy)

Method of determination

Determination of physical and chemical parameters is carried out on an automatic analyzer using the “dry chemistry” method.

Hardware microscope…

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410 RUB

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C-reactive protein (CRP, CRP)

C-reactive protein is an acute phase protein, a sensitive indicator of tissue damage during inflammation, necrosis, trauma.
Synonyms: Blood test for CRP; C-jet …

Up to 1 business day

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665 RUB

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Anaerobic culture, Routine. Bacteria Identification and Susceptibility

Detection of anaerobic flora in purulent-inflammatory processes.

Anaerobic microorganisms constitute the vast majority of normal human microflora…

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Gram Stain. Bacterioscopic examination of different smears.

Synonyms: Analysis of a Gram-stained smear.

Microscopic (bacterioscopic) examination of Gram-stained smear.

Brief description of the study Microscopic examination of a smear stained …

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Culture of wound exudates and tissues for microflora and determination of sensitivity to an extended spectrum of antimicrobials

Synonyms:
Wound/tissue Culture. Aerobic Bacteria Identification and Antibiotic Susceptibility extended testing.
Brief description of the study “Sowing wound discharge and tissues for microflora and determination …

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Culture of wound exudates and tissues for microflora, determination of sensitivity to antimicrobials and bacteriophages

Synonyms:
Wound/tissue Culture. Aerobic Bacteria Identification. Antibiotic Susceptibility and Bacteriophage Efficiency testing.
Brief description of the study “Sowing of wound discharge and tissues for microflora, determined …

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Culture of wound discharge and tissues for microflora and determination of sensitivity to antimicrobial drugs

Synonyms:
Wound/tissue Culture. Aerobic Bacteria Identification and Antibiotic Susceptibility testing.
Brief description of the study “Sowing of wound discharge and tissues for microflora and determination of sensi…

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Glucose (in the blood) (Glucose)

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Which doctors to contact

It is possible to prevent the development of cellulite at an early stage, so when the first symptoms appear, you should consult a dermatologist, a general practitioner (family doctor). It is recommended to consult a surgeon for patients with ulcerative skin defects, if necessary, surgical treatment of the ulcerative surface. Consultation

general practitioner

and

endocrinologist

is needed for chronic cellulite to exclude concomitant pathology and determine the required amount of diagnostic and therapeutic measures.

Treatment of cellulite

The basis of the treatment of infectious cellulite is antibacterial therapy, taking into account the sensitivity of the pathogen to certain drugs. Broad-spectrum antibiotics are used, which is associated with difficulties in laboratory verification of the pathogen. Antimicrobial treatment of cellulite involves the use of antibacterial agents active against streptococci and staphylococci for 5 to 10 days in the case of uncomplicated cellulitis. In severe forms of cellulitis, antibacterial therapy is carried out with the use of drugs that are effective against both strepto- and staphylococci, and gram-negative aerobic microorganisms, until negative culture results are obtained. If the inflammation is autoimmune, then antibiotics are not required. Corticosteroids are often prescribed to relieve inflammation.

Localized erysipelas and cellulite care includes bed rest and elevation of affected areas to reduce local swelling. Cool, sterile saline dressings relieve pain and are especially indicated in the presence of bullous lesions. Application of moist heat may help localize an abscess associated with cellulitis.

Note that local therapy is indicated only for bullous, hemorrhagic manifestations of the disease.

In most cases of typical cellulite, there is no need to prescribe local agents – systemic antibacterial drugs are sufficient.
In complex and severe cases, surgery may be required to remove gangrene, tissue necrosis.

Among physiotherapeutic methods, the use of ultraviolet irradiation, laser therapy and photodynamic therapy is recommended. Hyperbaric oxygen therapy is used in patients with progressive cellulitis, when surgical excision of pathological tissues may be crippling.

Complications

Cellulite treatment should be started as soon as the doctor prescribes it, and all recommendations must be fully followed. The patient should not stop treatment as soon as he feels better, otherwise the disease may spread, causing serious complications.

Complications of cellulitis can be abscesses, osteomyelitis, septic arthritis, thrombophlebitis, bacteremia, necrotizing fasciitis, as well as lymphangitis and glomerulonephritis.

Recurrent infection of the lower extremities may be complicated by the development of dermal fibrosis and thickening of the epidermis. In older people, cellulitis of the lower third of the lower leg may be complicated by thrombophlebitis. In addition, inflammation of the subcutaneous tissue can trigger the development of meningitis.
In severe cases, cellulitis turns into gangrene. In turn, gangrene is often complicated by necrosis, in which the affected skin and subcutaneous fat die off. And this can lead to sepsis and death.

Prevention of cellulite

In order to prevent cellulite recurrence, the use of bicillin administered intramuscularly is effective. The duration of bicillin prophylaxis is 3 years, one preventive course per year.

The success of preventive treatment of cellulite also depends on the effectiveness of therapy for diseases that predispose to the appearance and recurrence of cellulite – diabetes, foot mycosis, microcirculation disorders, carbohydrate metabolism.

To prevent cellulite, you need to observe personal hygiene, monitor the condition of the skin – it should always be clean, do not allow it to peel or crack.

You should not get carried away with local antibacterial agents, as this can lead to a violation of the natural microflora of the skin and a weakening of its barrier function.

For the prevention of cellulite and erysipelas, it is necessary to follow the general recommendations:

• be careful when handling raw fish, poultry or meat;
• when working with the ground, it is recommended to wear rubber gloves;
• treat fungal infections in a timely manner; skin wounds must be thoroughly washed so that the infection does not enter the underlying tissues;
• at the first symptoms of inflammation, you should consult a doctor.

Sources:

1. Plieva L.R. Cellulitis versus cellulite. Russian journal of skin and venereal diseases. 2015; 18(6). pp. 42-49.
2. Federal clinical guidelines for the management of patients with pyoderma. Russian Society of Dermatovenerologists and Cosmetologists. Moscow, 2015.
3. Plavunov N.F., Kadyshev V.A., Chernobrovkina T.Ya., Proskurina L.N. Features of the clinic and differential diagnosis of erysipelas. Review. Archive of internal medicine. 2017; 7(5). pp. 327-339. DOI: 10.20514/2226-6704-2017-7-5-327-339

IMPORTANT!

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.
For a correct assessment of the results of your analyzes in dynamics, it is preferable to do studies in the same laboratory, since different laboratories can use different research methods and units of measurement to perform the same analyzes.

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Juvenile cellulitis | IVAN FILLMORE VETERINARY CLINIC

Home – Juvenile cellulite

Juvenile cellulitis is an interesting and rare pathology that usually affects our youngest patients. It occurs in puppies from two weeks to six months. It is extremely rare for this pathology to be recorded in older dogs.

It is sad that not only the owners, but also many general practitioners are not informed about this disease. Hence, underdiagnosed animals and incorrectly prescribed treatment. It is extremely sad that, if left untreated, puppies with juvenile cellulitis can die.
Juvenile cellulitis is a sterile form of panniculitis (a deep skin lesion not initially complicated by bacterial inflammation), also called puppy wash (a similar disease in horses), bighead, juvenile pyoderma, juvenile sterile granulomatous dermatitis. The disease has a familial tendency (there may be several affected puppies in one litter). It occurs in different breeds, according to the literature data, the dachshund, golden retriever, Gordon setter, beagle and pointer are more predisposed. Has no sexual predisposition.

The pathogenesis of the disease is still unknown. But there are suggestions that the disease is immune-mediated in nature, because juvenile cellulitis responds well to hormone (steroid) treatment. There is an assumption that the mechanism that triggers the disease may be vaccination.

Clinical manifestations:

Begins with swelling of the muzzle and regional lymph nodes. The lesions are painful but usually not itchy. Lesions are symmetrical more often on the lips, eyelids, muzzle – these can be vesicles, pustules, serous and purulent exudate, crusts, cellulitis and alopecia; in advanced stages, fistulas occur. The auricles may be swollen, with exudation. In some puppies, lesions may occur on the prepuce and anus. Sometimes the rash spreads over the body. With the advanced form of juvenile cellulitis, abscesses of the lymph nodes can be observed. Dogs with severe lesions usually have depression, anorexia, and fever. In rare cases, aseptic purulent arthritis occurs, which is accompanied by severe joint pain and lameness. Atypical forms of the disease are described, when only the joints are affected.

Differential diagnoses:

Chin furunculosis, canine distemper, bacterial pyoderma, demadecosis, dermatophytosis (lichen), drug-induced dermatitis, angioedema. For some reason, many owners, breeders and, unfortunately, doctors confuse these diseases with allergies, although there is little in common between juvenile cellulitis and allergies. As a result, puppies receive inadequate treatment and the disease progresses to more severe stages.

Diagnosis:

1. A detailed history is taken – age, breed, location of lesions, absence of itching are taken into account.

2. Exudate cytology – a large number of non-degenerative segmented neutrophils and macrophages. In later stages, secondary bacterial inflammation may occur. Sometimes an additional puncture is done, followed by cytology from the affected lymph nodes.

3. Dermatohistopathology: diffuse pyogranulomatous dermatitis and panniculitis. Histology is relevant for atypical presentation or suspicion of juvenile cellulitis in an adult dog. For puppies, the presence of a characteristic picture and cytology is enough to make a diagnosis. Skin biopsies are only sent to laboratories that have an experienced histopathologist who specializes in dermatological diseases of dogs and cats. It takes at least 10 days to receive a histological conclusion. Therefore, your animal should receive treatment immediately, based on preliminary studies.

4. Cultures for bacterial and fungal cultures are usually negative.

5. Deep scraping for demodicosis is negative.

Treatment should only be prescribed by a veterinary dermatologist:

— Steroids are the main drugs for the treatment of juvenile cellulitis. The dosage should be immunosuppressive, and the course should be long from 1 to 4 weeks. When prescribing a short course, relapses are observed. Steroids have a number of side effects, so they are prescribed only by a doctor. One of the harmless side effects of polyphagia (increased appetite). One of my little patients became like a kolobok in 3 weeks of treatment. During treatment, be sure to monitor your pet’s serving size.

– Secondary bacterial infection is treated with antibiotics at the “correct” high dermatological dosage (minimum 3-4 weeks) and should be continued for at least 1 week after complete clinical and cytological recovery. It is very important for bacterial skin diseases to choose the right course and dosage of the drug. Antibiotics accumulate in the skin last, if the animal receives a short course of an antibiotic at a therapeutic dosage, this will lead to a rapid relapse, the emergence of resistant microflora strains, or the absence of a clinical effect. Antibiotics used to treat pyoderma are not hepatotoxic! and do not cause dysbacteriosis!

— Daily gentle local softening with warm water or chlorhexidine should be used to remove crusts and exudates.

— With severe blepharitis, additional eye drops or ointments with a glucocorticoid and an antibiotic are prescribed.