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By Biuce E. Ruben NB, Neuical Biiectoi of Encompass BealthCaie anu Wounu
Neuicine
www.encompasshealthcaie.com


0ui skin is oui laigest oigan anu peifoims a myiiau of functions, incluuing pain
sensation, piessuie sensitivity, tempeiatuie iegulation anu watei conseivation.

The skin is also oui fiist line of uefense against oui physical anu miciobial
enviionment. Anu although sheets anu sheets of bacteiia live haimoniously on the
skin, it is still impenetiable to even the smallest piotein molecules. Note: that's gieat
infoimation foi the next time you puichase anti-wiinkle piouucts that claim to get
below the skin.

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The most common oiganisms, Staph auieus anu uioups A-F Stieptococcus, encamp
in uioves on oui skin. But foi invasive uisease such as cellulitis to occui in the skin,
theie must fiist be a bieach in the skin's integiity. That's when the Staphs anu
Stieps auvance below anu cellulitis uevelops. This knowleuge makes antibiotic
selection easy anu iesponses to the antibiotics pieuictably goou when patients seek
attention eaily on in cases of cellulitis.

0thei less common causes of penetiating events such as animal anu human bite
wounus, neeule injections, nail punctuies anu blunt tiauma also have well known
miciobiology anu effective antibiotic tieatment is ieauily available when this histoiy
is known.

The caiuinal signs of inflammation, ieuness, heat, swelling anu pain, with
accompanying symptoms of fevei anu chills, aie obvious to both patient anu
piactitionei. Cultuies aie geneially unnecessaiy since Staph anu Stiep aie the
known intiuueis. Neaily all cases of cellulitis can be successfully manageu outsiue a
hospital touay since effective oial anu intiavenous antibiotics aie ieauily available
in an outpatient setting.

Still, cellulitis is exceeuingly iaie consiueiing the amount of skin uamaging events
that occui to oui skin ovei oui lifetimes. The legs anu feet aie the most common
aieas wheie cellulitis occuis. When cellulitis iecuis, piactitioneis know to look in
the webs between the toes wheie athlete's feet (tinea peuis) cieates the micioscopic
cuts that seive as a poital of entiy foi skin Staph anu Stiep. Simple antifungal
cieams bieak the cycle of ie-infection by tieating the cause of the skin uisiuption
anu healing the skin.
Cellulitis oi auvancing skin infections iaiely occui even in open, chionic, non-
healing wounus because oui next line of uefense, 11 tiillion white bloou cells maue
fiesh uaily, contain anu localize miciobiology to the wounu's suiface, theieby
piotecting the iest of oui suiiounuing skin anu the oigans below. This level of
piotection is compiehensive anu efficient.

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In the iaiest of events, cellulitis may auvance uue to eithei an extiaoiuinaiily
viiulent oiganism oi pooi host conuitions. It can uestioy skin anu the stiuctuies
below, spilling into oui bloou stieam (bacteiemia), anu thieatening oui lives
(sepsis). In only these ciicumstances will hospitalization be iequiieu foi intensive
fluiu anu iespiiatoiy suppoit, anu the possible suigical excision of iapiuly
auvancing gangiene (skin ueath).

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In shoit, cellulitis is a ielatively iaie infectious uisease causeu by Staph oi Stiep
bacteiia that entei the bouy thiough a bieach in the skin. 0nce an attack of cellulitis
has been uiagnoseu, uoctois piesciibe antibiotics that taiget anu uestioy the
invauing bacteiia. 0ial antibiotics aie effective in iesolving the majoiity of cellulitis
cases anu when they'ie not, highei concentiations can be auministeieu
intiavenously. Combineu with excellent wounu caie to iestoie skin integiity anu
piopei nutiition, cellulitis can iesolve quickly.


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