Assessing and managing cellulitis

This is a summary of the peer-reviewed article: Diagnosing, assessing and managing cellulitis by Heather Newton

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The article provides an overview of cellulitis and its nursing management. Cellulitis is an acute bacterial infection of the deep dermis and surrounding subcutaneous tissue. Although it is a common condition, it is often misdiagnosed because it can mimic a range of conditions that also cause inflamed, red, irritated and painful skin. Such misdiagnoses may lead to unnecessary hospital admissions and antibiotic overuse, with most alternative diagnoses being non-infectious. Erysipelas, a more superficial form of cellulitis, and necrotising fasciitis, a severe variant involving the fascia, are treated similarly but vary in severity and urgency.

Common causes and risk factors

Cellulitis is most often caused by beta-haemolytic streptococci and meticillin-sensitive Staphylococcus aureus (MSSA), with methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa less common pathogens.

Risk factors include a history of cellulitis, compromised skin integrity, obesity, diabetes mellitus and long-term conditions such as oedema, which increase the risk of recurrence.

Symptoms and diagnosis

Cellulitis typically presents with red, swollen and painful skin, sometimes accompanied by fever and malaise. On darker skin tones, it may appear as dark brown, grey or purple. Severe cases can lead to blistering and ulceration. Diagnosis is primarily clinical, supported by blood tests, swabs and cultures where necessary.

Management

The management of cellulitis varies by severity:

• Mild cases – treated with oral antibiotics in the community.

• Severe cases – require hospitalisation and intravenous antibiotics, with flucloxacillin as the first-line treatment. Additional interventions include pain management, limb elevation and compression therapy.

Nursing role and wound care

Undertaking a holistic patient assessment, skin assessment and thorough clinical history is important in the diagnosis of cellulitis, and it is vital to use a collaborative multidisciplinary approach in its acute management and to prevent recurrence.

Nurses have a crucial role in undertaking wound care, selecting appropriate dressings such as antimicrobial or absorbent dressings, and regularly reviewing the patient’s care plan to ensure the dressings are contributing to healing.

Prevention and patient education

Preventing recurrence involves patient education on skin health maintenance, managing underlying conditions and early infection monitoring. Regular washing, use of emollients and fungal infection checks are recommended, especially for patients with diabetes.

Importance of effective management

Effective management of cellulitis improves patient outcomes and reduces the healthcare costs associated with recurrent infections and hospital admissions.

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