Introduction

Cellulitis is defined as the acute infection of the sub-cutaneous tissue and dermal layer. It is an infectious disease which is responsible for unwholesomeness (morbidity) and loss of life (mortality). It is a micro-organism infection where the skin is concerned. It is considered as an epidemic disease which affects both adults and children. Cellulitis can be classified into five types (Linder & Malani, 2017).

Cellulitis occurs due to two species. They are Streptococci (streptococcus pyogenes) and Staphylococcus aureus. In that, the most identified cause is Staphylococcus aureus. Cellulitis requires hospitalization in extreme condition. Computed Tomography (CT) scanning is used in determining cellulitis. However, X-rays are not required in most cases, but in some cases, it is needed (Chiras, 2010).

Moreover, people’s caution in cleanliness and their knowledge in vaccine progression had a phenomenal decline in the disease’s cellulitis. Non- Steroidal

Anti-inflammatory Drugs (NSAID’S) are administered to reduce the inflammation signs, but the bacteria are proliferated as a side effect of Non-Steroidal Anti-inflammatory Drugs (NSAID’S). Anti-bacterial drugs such as Dicloxacillin, Clindamycin, and Levofloxacin are prescribed to cure cellulitis. Superficial cellulitis, which involves lymphatic activity known as Erysipelas, does have an indurated, raised border that demarcates it from normal skin. These distinctive features create a “peau d’orange” appearance (Fleisher & Ludwig, 1980).

Types of Cellulitis

Cellulitis is of different types depending on where the infection occurs. They are five types of cellulitis (Table 1) such as facial cellulitis, periorbital cellulitis, orbital cellulitis breast cellulitis and perianal cellulitis (Maitre, 2006).

Clinical indications

The clinical features are discussed below

First line features

• Reddishness

• Ache

• Soreness

• Swellings

Clinical indicators

• Formation of abscess in the leg

• Pyrexia

• Chillness

• Increasing heartbeat

• Head pain

• Reduction in the blood pressure level (Christensen et al., 2009).

Pathophysiology

• Cellulitis is an infection of the subcutaneous tissue and dermal layer. It happens in the skin by the entry of pathogens into the dermis skin’s layer.

• The phalanges webspace bacteria, fungal, foot infections pressure ulcers and venous leg ulcers these things cause the cutaneous barrier disruption.

• The lowest level surface pH, low point temperature and commensal micro-organisms availability decrease the skin external pathogenic organism’s expansion (Cranendonk, Lavrijsen, Prins, & Wiersinga, 2017).

In cellulitis,

• Swelling in the inner layer of skin

• Lymphatic dilation

• Dispersed huge impartial filtration on every side of the bloodvessel (Gundersoncg, 2012).

The above-mentioned characteristics are the cytological characteristics of cellulitis. In the next step, the lymphocytes, as well as histocytes, also incorporates as its biological characters. Commonly the unfavourable conclusion is because of the cultures performed with needle aspiration or biopsy. When the bacteria’s concentration is in a short amount, it gives favourable outcomes. This study indicates that a very low number of bacteria are accountable for the inauguration of sturdy provocative reaction (Bruun et al., 2016).

Microbiology

In adults, cellulitis occurs due to two species. They are as follows,

• Streptococci (streptococcus pyogenes)

• Staphylococcus aureus

In a review by (Raff & Kroshinsky, 2016) in the year 2016, 1000 adults and children patients in the United States of America (USA) had undergone needle aspiration or punch biopsy. 16% of them had civilizations that established a bacterial diagnosis. And in a favourable conclusion, it is identified that 5% were Staphylococcus aureus and 27% were streptococcus pyogenes. Bacteria like Haemophilus influenza may cause cellulitis and it causes facial cellulitis in young children (Ginsberg, 1981).

Risk Factor’s For Cellulitis

Edema is considered as the not uncommon risk factor for cellulitis. The lymphedema is the specific risk factor since bacterial growth is aided by the lymphatic fluid. Fluid is supposed to facilitate bacterial growth (Raff et al., 2016).

The patient is at risk or dangerous state if they have the following,

1. Diabetes mellitus

2. Injury in the skin

3. Inflammation in the liver (Hepatitis)

4. Circulatory complications like not enough blood flow to the arms and legs, poor drainage of veins

• Dermatological issues like eczema, psoriasis, which may lead to chickenpox (Yarbrough, Kukhareva, Spivak, Hopkins, & Kawamoto, 2015).

5. Dermatological issues like eczema, psoriasis, which may lead to chickenpox (Yarbrough et al., 2015).

Identification of Cellulitis

There are no diamond calibre approaches to identify cellulitis (Levell, Wingfield, & Garioch, 2011).

• It is detected based on the corporal (physical) check-up and the patient’s previous medical records.

• Computed Tomography (CT) scans as well as ultrasound is used to discover deeper infections like abscesses.

• Additionally, a blood test is required if the medical officer suspects that it may spread to your blood.

• X-rays are needed if a foreign particle present in the skin or behind the bone.

• Moreover, it is spotted by visual inspection too.

• In cellulitis, Pastecurella multicoida is combined with animal bites, maximum in cat bites (Griegord & Orengoif, 1995).

Treatment

Antibiotics are prescribed to cure cellulitis. It is administered orally for most of the patients. Hospitalization is required for extreme stages of cellulitis. During hospitalization, the antibiotics are administered in the intravenous IV route (Abrahamian & Goldstein, 2011).

In some cases, the antibiotics are prescribed for many weeks and even months, this is followed only if the patients often suffer from severe cellulitis, if not, antibiotics are prescribed only for a limited duration. Also, Non-Steroidal Anti-Inflammatory Drugs are prescribed to treat cellulitis (Daum, 2007).

Drugs Used in Cellulitis

The Non – Steroidal Anti-Inflammatory Drugs and Anti-bacterial drugs are administered to treat cellulitis and this is discussed briefly in the Table 2. Beta-lactam antibiotics having activity against penicillinase-producing S. aureus are the drugs of choice. Cefazolin (first generation cephalosporin), nafcillin (synthetic penicillin) and ceftriaxone (third-generation cephalosporin) are initial treatment options for cellulitis (Chosidow, 1991).

If the patient is suspected to have methicillin-resistant S. aureus (MRSA) or is highly allergic to penicillin, then linezolid and vancomycin can be treated for cellulitis. IV should be given as an initial treatment in the hospital if the inflammation is spreading very rapidly or if the patient has a significant systemic response such as chills and fever or occurrence of any complicating conditions like neutropenia, cardiac failure, immuno suppression, or renal insufficiency (Madaras-Kellykj, Remingtonre, Oliphantcm, & Sloankl, 2008). Structures, Molecular weight, Metabolism, Excretion, Generic name and Brand Name half- life period (t_1/2), Drug interactions and toxicity of the drugs are discussed in Table 3.

Preventive Measures

• As there is a famous proverb, “cleanliness is next to godliness” here, in this cellulitis condition, cleanliness will prevent the cellulitis infection.

• Maintaining good hygiene like washing hands properly will be the best preventive measure.

• If the person has dry skin, he/she is advised to intake plenty of water.

• Also, applying lotion or ointment to the braked skin will be an effective preventive measure.

• It is advised to have the avoidance antibiotic, which is prescribed by your Medical officer (Thomas et al., 2013).

Discussion

Majority of the patients who are affected with cellulitis gets a quick response to the antibiotics. In unusual cases, the cellulitis may reach the systemic circulation and it becomes complicated. In some rare cases, surgery is needed to clear the abscess, also to detach the deceased tissue (Karppelinm & Vuopio-Varkilaj, 2010).

Conclusions

Cellulitis is an infectious clinical condition where micro-organism is concerned. It is an antibacterial skin disease where it has to be treated effectively at the early stage. Cellulitis is considered a general global issue and it could be reduced by curing its risk factor. Various information about Cellulitis has been discussed in this article and it can be treated with prior knowledge, even with low-cost antibiotics.

Acknowledgements

The authors are thankful to the Faculty of Pharmacy and thankful to the management of Dr MGR Educational and Research Institute for providing this opportunity.

Conflict of Interest

The authors declare that they have no conflict of interest.

Funding Support

The authors declare that they have no funding support for this study.