People in off-grid settings are often called upon to perform activities to which they’re not accustomed. In daily survival, the inexperienced will suffer mishaps that lead to injury; in situations where sanitation is questionable, these injuries carry a risk of infection, especially in unsanitary conditions. One of these is known as “cellulitis.”

WHAT IS CELLULITIS?

The term cellulitis commonly is used to indicate an inflammation of the skin and soft tissues, usually from acute infection. Once under the skin, subcutaneous fat, muscle layers, nerves, and blood vessels may become involved.

Why does cellulitis occur? When the skin is breached, various microbes can invade and cause damage. Inflammation in soft tissues may develop when bacteria enter through a crack or break in your skin. Fortunately, infections from minor wounds are relatively easy to treat today due to the availability of antibiotics. Without them, any bacteria may become life-threatening if it enters and multiplies in the circulation, a condition known as “septicemia.”

Cellulitis may be easy to deal with in normal times with a short course of antibiotics, but it will be an epidemic in the aftermath of a major disaster. This is not because it’s contagious; unless there is an open wound or an exchange of bodily fluids, caregivers can treat the victim safely.

Without antibiotics, infections can spread to lymph nodes and the bloodstream, rapidly becoming life-threatening. The end result might affect the entire body, referred to as “sepsis.” Once sepsis develops, inflammation of deep structures like the spinal cord (“meningitis”) or bone marrow (“osteomyelitis”) can further complicate the situation. In the past, sepsis was usually fatal. Even today, it is certainly life-threatening.

The bacteria that can cause cellulitis are on your skin right now. Normal inhabitants of the surface of your skin include Staphylococcus and Group A Streptococcus. They do no harm until the skin is broken and they enter deeper tissues where they don’t belong.  Points of entry include dry, flaky or swollen skin, such as through a recent surgical site, cuts, puncture wound, skin ulcer, athlete’s foot, or other irritation.

In recent years, a resistant bacterium called MRSA (Methicillin-Resistant Staphylococcus Aureus) has arisen which causes cellulitis resistant to the usual antibiotics.

(Note: As an aside, Cellulitis has nothing to do with the dimpling on the skin called “cellulite”. The suffix “-itis” simply means “inflammation”, so cellul-itis simply means “inflammation of the cells.”)

WHO GETS CELLULITIS

any break in the skin can lead to cellulitis

In a survival setting, anyone can. In normal times, several factors increase the risk:

• Injuries such as cuts, fractures, burns, or scrapes gives bacteria an entry point.
• Conditions or medications that weaken the immune system increase the risk of infection. Diabetes or leukemia are examples.
• Skin conditions such as ezcema, psoriasis, shingles, or athlete’s foot can cause breaks in the skin that serve as entry points for bacteria.
• Chronic swelling of extremities, also called “lymphedema,” which may occur after surgery for breast cancer and other conditions.
• A previous history of cellulitis increases the risk of getting it again.
• Excess weight can predispose to the development of cellulitis.

SIGNS AND SYMPTOMS OF CELLULITIS

The signs and symptoms of cellulitis must be recognized as early as possible. They include:

• Discomfort in the area of infection (a common first sign).
• Heat in the area of the infection compared to non-affected areas.
• Redness, usually spreading towards torso.
• Swelling in the area of infection (often appearing shiny and causing a sensation of tightness).
• Drainage of pus or cloudy fluid from the area of the infection.
• Foul odor coming from the area of infection.
• Fever and chills.
• Exhaustion (fatigue).
• General ill feeling (also called “malaise”).
• Muscle aches (known as “myalgia”).
• Joint stiffness caused by swelling of the tissue over it.

TREATING CELLULITIS

You’ll most often see cellulitis  in an extremity, such as a leg. In these cases, it’s helpful to keep the limb elevated. Other strategies include warm or cool compresses/soaks to the affected area, and the use of ibuprofen (Advil) or acetaminophen (Tylenol) to decrease pain, discomfort, and fever. If the wound is open or weeping fluid or pus, cover it with a non-stick dressing. Otherwise, try to avoid touching the area.

Some practitioners recommend compression dressings to keep down swelling. If you choose this option, be careful to avoid wrapping too tightly, as it can impede circulation.

 

To follow the progress of healing, use a felt-tip marker to outline the borders of the red, warm areas associated with the cellulitis. If the redness recedes, progress is being made towards healing. Concern increases if the redness breaks through the borders.

Although the body can sometimes resolve cellulitis on its own, a significant case is often given treatment which includes the use of antibiotics. These can be topical, oral, or intravenous.

It should be noted that topical therapy with antibiotic creams helps more to prevent infection than cure it.

High fever, spreading redness, warmth, pain, and swelling are signs that you’re dealing with a severe case. In normal times, intravenous antibiotics are indicated. Lacking these, the survival medic can try a combination of oral antibiotics.

As most cases of cellulitis are caused by bacteria, drugs in the penicillin, erythromycin, or cephalosporin families, given for 7-14 days, should eliminate the infection. Amoxicillin, Augmentin (amoxicillin with clavulanic acid), and ampicillin are particularly popular, but penicillin is still used by some. Azithromycin, clindamycin, doxycycline, and metronidazole are options in those allergic to penicillins. MRSA cellulitis can be treated with clindamycin and the sulfa drug combination of sulfamethoxazole/trimethoprim (SMX-TMP).

Whichever antibiotic is used, it’s important to complete the full course of therapy to assure eradication of the offending germ.

(Note: How is amoxicillin with clavulanic acid (brand name Augmentin) different from regular amoxicillin? Augmentin can treat similar infections to amoxicillin plus some other infections that may have developed antibiotic resistance against amoxicillin, such as persistent ear infections.)

Some adult dosing examples:

• Penicillin, amoxicillin, cephalexin, or ampicillin 250-500 mg orally four times a day for 7-14 days (Amoxicillin also comes in 875 mg).
• Augmentin (amoxicillin with clavulanic acid) 500-875 mg every 12 hours or 250-500 mg every 8 hours for 7-10 days.
• Azithromycin 500 mg once on Day 1, followed by 250 mg a day on days 2-5
• Clindamycin 150-300 mg  three times a day for 7-10 days.
• SMX 800 mg/TMX 160 mg  twice a day for 7-10 days.
• Doxycycline 100 mg twice a day for 7-10 days.

It should be noted that variations on dosing and duration of therapy vary from infection to infection. For more information, consider a copy of “Alton’s Antibiotics and Infectious Disease: The Layman’s Guide…”.

In resistant infections like MRSA, combination therapy with SMX/TMP 880/160 mg and cephalexin 500 mg orally four times a day for 7-14 days may be necessary. As with all medications, allergic reactions and other adverse effects may occur. The longer the therapy and the higher the dose, the more likelihood that adverse reactions may occur.

PREVENTION OF CELLULITIS

An ounce of prevention is worth a pound of cure. Using appropriate hand and foot protection and eyewear will help prevent many injuries, especially among the inexperienced performing activities of daily survival.

If an injury occurs, stop what you’re doing and immediately wash the wound with soap and water or an antiseptic like povidone-iodine (Betadine) or chlorhexidine (Hibiclens).

(Note: I failed to do this after an agave spine penetrated my shin because I was “in the middle” of a project. Big mistake. By the next morning, an angry, red cellulitis had developed.)

Encouraging good hygiene will also help decrease the chance of developing cellulitis. Promote regular washing with soap and water and check hands and feet for signs of injury. Consider treating dry skin with moisturizers to prevent cracking and peeling (avoid applying on open wounds, however). Keep group members’ fingernails and toenails trimmed. Watch for minor issues like athlete’s foot that could lead to worse problems.

All the drugs mentioned in this article are available in veterinary equivalents (at least at present). In a survival situation, however, antibiotics will be precious commodities. The family medic should dispense them only when absolutely necessary. The misuse of antibiotics, along with their excessive use in livestock, is part of the reason that we’re seeing an epidemic of antibiotic resistance in this country.

Having said that, I write about off-grid post-disaster scenarios. If you’re medically responsible for a family or mutual assistance group in times of trouble, you’ll be glad you stockpiled some antibiotics along with the bandages and antiseptics. Use them judiciously and you’ll save lives.

Joe Alton MD

Learn more about cellulitis and over 200 other medical topics in survival settings with the award-winning 4th edition of the Survival Medicine Handbook: The Essential Guide For When Help Is NOT On The Way,” and other books by Joe Alton MD and Amy Alton NP. Also, get your family more medically prepared with quality kits and individual supplies from our entire line at store.doomandbloom.net. You’ll be glad you did.

 

 

 

 

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