Cellulitis
The skin is the largest organ of the body and like many other organs of the body is at risk for infection. When there is alteration in skin integrity such as cuts, burns, or scrapes, the risk for bacterial infections is great. There are many skin disorders and alterations that can occur, but for the remainder of this discussion we will cover cellulitis and its underlying pathology. As previously mentioned, alterations in skin integrity are a major factor in the formation of cellulitis. Risk factors for cellulitis include breaks in the skin barrier such as insect or animal bites, intravenous site punctures, fissures between toes, and surgical incisions (Brown et al., 2025). Additionally, patients with comorbidities such as venous insufficiency, lymphedema, diabetes mellitus, and peripheral arterial disease have a greater risk of developing cellulitis (Brown et al., 2025).
Pathophysiological Mechanisms
Cellulitis begins with the breakdown of skin integrity, which provides a pathway for bacteria to enter the dermis of the skin and subcutaneous tissue resulting in inflammation. Cellulitis is unilateral and smooth with indistinct borders (Dlugasch & Story, 2023). The most common bacterial organism related to the development of cellulitis is Group A Streptococci (Brown et al., 2025). Patients may present with elevated white blood cell count indicative of infection. Fever may also be present with reports of malaise and joint pain (Dlugasch & Story, 2023). The affected area presents warmth, edema, erythema, and tenderness upon palpation. The occurrence of tenderness is related to the cytokine and neutrophil response to the presence of bacteria that have breached the epidermis (Brown et al., 2025). The response mechanism resulting from cytokine and neutrophils triggers the production of antimicrobial peptides and keratinocyte proliferation which reflect in the symptoms characteristics and clinical findings that accompany cellulitis.
Complications
One of the greatest complications of cellulitis lies in the recurrence of infections. In addition to the potential for reoccurrence, delayed treatment of cellulitis can result in major complications. Without prompt treatment, the bacteria can go beyond the affected tissue areas and spread to the blood stream resulting in bacteremia. Bacteremia is the presence of bacteria in the bloodstream. If this complication of cellulitis is not effectively managed or goes untreated, the progression of sepsis can occur. This can be life-threatening as it can lead to shock and organ failure. Infected blood navigating through the circulatory system can spread bacteria to distant organs and create a domino effect in complications.
Patients can develop infective endocarditis, abscess formation, and osteomyelitis because of sepsis increasing chances of morbidity or mortality (De Morais et al., 2025). Necrotizing fasciitis can also result from untreated cellulitis and aggressively destroys skin, fat, muscle, and other nearby tissues in the presence of bacteria. The toxins released from the bacteria disrupt blood flow and break down tissue material. Additional complications from the formation of necrotizing fasciitis include multisystem organ failure and gangrene due to gram-positive group A Streptococcus (Dlugasch & Story, 2023). Prompt treatment is essential in preventing complications of cellulitis. Patients with underlying conditions that place them at risk should be educated on control of underlying conditions to prevent formation or reoccurrence.
References
Brown, B. D., Syed, H. A., & Watson, K. L. H. (2025, December 13). Cellulitis. StatPearls -Bookshelf.
Dlugasch, L., & Story, L. (2023). Applied Pathophysiology for the advanced practice nurse. Jones & Bartlett Learning.
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