Q: I recently had my fourth bout of cellulitis. I believe the first occurrence came about as the result of our dog scratching my leg. The week it first occurred was also a very stressful one and I came down with a cold just prior to it manifesting itself. I then got it twice within the next twelve months. I just recently got it again right before a trip to Europe.
I was given ciprofloxacin each time which kept it in check but which has obviously not gotten to the root of the problem. Where should I turn to try and get rid of this recurring problem? Also, does stress and a compromised immune system contribute to this recurring?
A: Cellulitis is a bacterial infection that can occur when one of several forms of bacteria enter a crack or break in the skin. The two most common types of bacteria involved are streptococcus and staphylococcus. A more serious form of staph cellulitis is known as methicillin-resistant staphylococcus aureus (MRSA), with the number of cases being on the rise. Bacteria can enter as the result of a scratch, cut, surgical site, puncture wound, bite, or injury that causes a break in the surface. Some spiders and insects can also transmit the bacteria.
Generally, when our skin becomes damaged, we clean the area and perhaps treat it with an antibacterial agent; the wound heals without fanfare. In the instance of cellulitis, the skin tissues at the infection site become red, hot and painful. Those areas of our body most commonly affected are the lower legs. The condition is serious, so rapid intervention by a health care professional and the prescribing of antibiotics are of utmost importance. The first telltale signs are pain, redness, swelling and warmth to the touch. The patient may have fever, chills, muscle aches and pains.
Specific conditions can place an individual at increased risk for cellulitis. One such case is in the person with a weakened immune system, such as those having leukemia, HIV/AIDS, liver or kidney disease, diabetes, poor circulation, or being placed on corticosteroids. Then there’s a past history. Individuals who have previously had cellulitis are more likely to develop it again than the general population. You don’t indicate whether you are fit and trim or obese, but the latter will also increase your risk of repeat bouts. Scars from vein removal are common areas for recurrent infection. In response to your question of stress as a possible cause for recurrence, I can only guess that you might be compromising your immune system with the added stress in your life so there may be a connection that remains undocumented by the medical field. However, one test you can attempt to consider is to avoid stress whenever possible, use viable alternatives when in an uncompromising-appearing situation to lessen that stress and see what follows. If you remain free from cellulitis, you will have your answer.
Diagnosis can be made through visual examination of the wound, wound culture, or blood tests. If the site is in the lower leg, testing might additionally include ruling out a blood clot which can present with pain, swelling, warmth to the touch or an abscess (a collection of pus under the skin).
Treatment commonly consists of an oral antibiotic and will be taken for approximately one to two weeks. Precautions to fight against repeat bouts include washing any open areas with an antibacterial soap, using an over-the-counter antibiotic cream or ointment, and watching for the telltale redness, pain and drainage. You don’t mention having diabetes but extra attention should be paid to areas of skin on your body that may be dry and subject to cracking. Keep your skin lubricated with a good moisturizer. Wear appropriate shoes and other footwear that allows your feet ample room to stretch. I further recommend you visit a specialist in the field of infection such as an infectious disease specialist who might be able to shed some light on your concerns and determine if anything can be done to eradicate the problem once and for all.
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