Cellulite and Cellulitus are not the same or related conditions

Cellulitis facts

• Cellulitis is a spreading bacterial infection of the skin and tissues beneath the skin.

• Staphylococcus and Streptococcus are the types of bacteria that are usually responsible for cellulitis, although many types of bacteria can cause the condition.

• Sometimes cellulitis appears in areas where the skin has broken open, such as the skin near ulcers or surgical wounds.

• Cellulitis is not contagious.

• Cellulitis is treated with oral or intravenous antibiotics.

What is cellulitis?

Cellulitis is a bacterial infection of the skin and tissues beneath the skin. Unlike impetigo, which is a very superficial skin infection, cellulitis is an infection that also involves the skin's deeper layers: the dermis and subcutaneous tissue. The main bacteria responsible for cellulitis are Streptococcus and Staphylococcus ("staph"), the same bacteria that can cause impetigo. MRSA (methicillin-resistant Staph aureus) can also cause cellulitis. Sometimes, other bacteria (for example, Hemophilus influenzae, Pneumococcus, and Clostridium species) may cause cellulitis as well.

Cellulitis is fairly common and affects people of all races and ages. Men and women appear to be equally affected. Although cellulitis can occur in people of any age, it is most common in middle-aged and elderly people.

What are cellulitis symptoms and signs?

Cellulitis usually begins as a small area of tenderness, swelling, and redness that spreads to adjacent skin. As this red area begins to enlarge, the affected person may develop a fever, sometimes with chills and sweats, tenderness, and swollen lymph nodes ("swollen glands") near the area of infected skin.

Where does cellulitis occur?

Cellulitis may occur anywhere on the body, but the lower leg is the most common site of the infection (particularly in the area of the tibia or shinbone and in the foot; see the illustration below), followed by the arm, and then the head and neck areas. In special circumstances, such as following surgery or trauma wounds, cellulitis can develop in the abdomen or chest areas. People with morbid obesity can also develop cellulitis in the abdominal skin. Special types of cellulitis are sometimes designated by the location of the infection. Examples include periorbital (around the eye socket) cellulitis, buccal (cheek) cellulitis, facial cellulitis, and perianal cellulitis.

What does cellulitis look like?

The signs of cellulitis include redness, warmth, swelling, tenderness, and pain in the involved tissues. Any skin wound or ulcer that exhibits these signs may be developing cellulitis.

Other forms of noninfected inflammation may mimic cellulitis. People with poor leg circulation, for instance, often develop scaly redness on the shins and ankles; this is called "stasis dermatitis" and is often mistaken for the bacterial infection of cellulitis.

What are cellulitis risk factors?

Most commonly, cellulitis develops in the area of a break in the skin, such as a cut, small puncture wound, or insect bite. In some cases when cellulitis develops without an apparent skin injury, it may be due to microscopic cracks in the skin that is inflamed or irritated. It may also appear in the skin near ulcers or surgical wounds.

In other circumstances, cellulitis occurs where there has been no skin break at all, such as with chronic leg swelling (edema). A preexisting skin infection, such as athlete's foot (tinea pedis) or impetigo can predispose to the development of cellulitis. Likewise, inflammatory conditions of the skin like eczema, psoriasis, or skin damage caused by radiation therapy can lead to cellulitis.

People who have diabetes or conditions that compromise the function of the immune system (for example, HIV/AIDS or those receiving chemotherapy or drugs that suppress the immune system) are particularly prone to developing cellulitis.

Conditions that reduce the circulation of blood in the veins or that reduce circulation of the lymphatic fluid (such as venous insufficiency, obesity, pregnancy, or surgeries) also increase the risk of developing cellulitis.

What causes cellulitis?

The majority of cellulitis infections are caused by infection with either strep (Streptococcus) or staph (Staphylococcus) bacteria.

The most common bacteria that cause cellulitis are beta-hemolytic streptococci (groups A, B, C, G, and F). A form of rather superficial cellulitis caused by strep is called erysipelas and is characterized by spreading hot, bright red circumscribed area on the skin with a sharp, raised border. Erysipelas is more common in young children. The so-called "flesh-eating bacteria" are, in fact, also a strain of strep bacteria that can sometimes rapidly destroy tissues underneath the skin.

Staph (Staphylococcus aureus), including methicillin-resistant strains (MRSA), is another common type of bacteria that causes cellulitis. There is a growing incidence of community-acquired infections due to methicillin-resistant S. aureus (MRSA), a particularly dangerous form of this bacteria that is resistant to many antibiotics, including methicillin, and is therefore more difficult to treat.

Cellulitis can be caused by many other types of bacteria. In children under 6 years of age, H. flu (Hemophilus influenzae) bacteria can cause cellulitis, especially on the face, arms, and upper torso. Cellulitis from a dog or cat bite or scratch may be caused by the Pasteurella multocida bacteria, which has a very short incubation period of only four to 24 hours. Aeromonas hydrophilia, Vibrio vulnificus, and other bacteria are causes of cellulitis that develops after exposure to freshwater or seawater. Pseudomonas aeruginosa is another type of bacteria that can cause cellulitis, typically after a puncture wound.

Is cellulitis contagious?

Cellulitis is not contagious because it is an infection of the skin's deeper layers (the dermis and subcutaneous tissue), and the skin's top layer (the epidermis) provides a cover over the infection. In this regard, cellulitis is different from impetigo, in which there is a very superficial skin infection that can be contagious.

How is cellulitis diagnosed, and what is the treatment for cellulitis?

First, it is crucial for the doctor to distinguish whether or not the inflammation is due to an infection. The history and physical exam can provide clues in this regard, as can sometimes an elevated white blood cell count. A culture for bacteria may also be of value, but in many cases of cellulitis, the concentration of bacteria may be low and cultures fail to demonstrate the causative organism. In this situation, cellulitis is commonly treated with antibiotics that are designed to eradicate the most likely bacteria to cause the particular form of cellulitis.

When it is difficult or impossible to distinguish whether or not the inflammation is due to an infection, doctors sometimes treat with antibiotics just to be sure. If the condition does not respond, it may need to be addressed by different methods dealing with types of inflammation that are not infected. For example, if the inflammation is thought to be due to an autoimmune disorder, treatment may be with a corticosteroid.

Antibiotics, such as derivatives of penicillin or other types of antibiotics that are effective against the responsible bacteria, are used to treat cellulitis. If the bacteria turn out to be resistant to the chosen antibiotics, or in patients who are allergic to penicillin, other appropriate antibiotics can be substituted. Sometimes the treatment requires the administration of intravenous antibiotics in a hospital setting, since oral antibiotics may not always provide sufficient penetration of the inflamed tissues to be effective. In certain cases, intravenous antibiotics can be administered at home.

In all cases, physicians choose a treatment based upon many factors, including the location and extent of the infection, the type of bacteria causing the infection, and the overall health status of the patient.

Can cellulitis be prevented?

Under some circumstances, cellulitis can be prevented by proper hygiene, treating chronic swelling of tissues (edema), care of wounds or cuts. In other cases, microscopic breaks in the skin may not be apparent and infection may develop. In general, cellulitis in a healthy person with an intact immune system is preventable by avoiding skin surface wounds. In people with predisposing conditions (see above) and/or weakened immune systems, cellulitis may not always be preventable.

What is the outlook/prognosis for cellulitis?

Cellulitis is a treatable condition, but antibiotic treatment is necessary to eradicate the infection and avoid spread of the infection. Most cellulitis can be effectively treated with oral antibiotics at home. Sometimes hospitalization and intravenous antibiotics are required if oral antibiotics are not effective. If not properly treated, cellulitis can occasionally spread to the bloodstream and cause a serious bacterial infection of the bloodstream that spreads throughout the body (sepsis).

The foods we eat can affect our risk of developing certain types of cancer. High energy and high fat diets can lead to obesity and are generally thought to increase the risk of some cancers. Plant-based diets high in fresh fruits, vegetables, legumes and wholegrain foods may help to prevent cancer.

Diet is just one of the lifestyle factors that influence the risk of developing cancer. Smoking, obesity, alcohol, sun exposure and physical activity levels are also important. Although some foods can affect cancer risk, there is no evidence that specific foods can cause or cure cancer.

Food and some common cancers
Some common cancers (and how they are affected by what we eat) include:

• Lung cancer – this is the leading cause of death from cancer in the world and smoking is mostly responsible. There is convincing evidence that diets high in vegetables and fruits are protective against lung cancer. It is thought that compounds called carotenoids (present in significant amounts in fruits and vegetables), as well as vitamin E, are probably responsible for some of this effect. However, the use of antioxidant supplements, such as beta-carotene and vitamin E, has not been proven to be effective in either prevention or treatment of lung cancer and may, in fact, increase the risk of developing cancer in those who smoke. While fruits and vegetables may offer some degree of protection, not smoking in the first place is by far the best prevention.

• Breast cancer – this is the most common type of cancer in women in the world. There is an increased risk of breast cancer with factors such as rapid early growth, greater adult height and weight gain in adulthood. Much of the risk of developing breast cancer involves factors that influence oestrogen levels during a woman’s reproductive life, such as age of menarche (first period), number of pregnancies and breastfeeding practices. Post menopausal women who are carrying too much weight, especially around their middle, have more than twice the average risk of breast cancer. Diets high in mono-unsaturated fat and high in vegetables and fruits may reduce the risk, while alcohol consumption increases the risk.

• Prostate cancer – a quarter of all new cancers diagnosed in men in UK is prostate cancer. Vegetables, soy in particular may decrease the risk, while a high fat diet that comprises mostly animal fat sources (such as dairy products, fatty meats and takeaway foods) may increase the risk. Lycopene is a potent antioxidant found in tomatoes, tomato-based products, watermelon and strawberries. It may also help lower the risk of prostate cancer.

• Bowel cancer – this is the fourth most common cancer in the world. Up to 70 per cent of cases can be prevented by following a healthy lifestyle. Keeping a healthy weight, being physically active and a diet high in vegetables and fibre are protective, while consuming a large amount of red meat (especially processed meat) and alcohol may increase the risk.

Foods to ‘eat less’
Foods to limit in your diet or eat less of include:

• Fatty processed red meats

• Highly processed foods that are low in fibre

• Heavily salted and pickled foods.

Foods to ‘eat more’
The strongest protective anti-cancer effect has been shown with:

• Vegetables, especially raw vegetables or salads

• Leafy green vegetables

• Carrots

• Tomatoes

• Citrus fruits

• Cruciferous vegetables like broccoli, cabbage, brussels sprouts, bok choy and other Asian greens.

Include more of these vegetables and fruits in your diet along with other varieties.

Seven a day
Eating seven or more serves daily of a variety of grains, grain products, legumes, roots and tubers will also provide protective benefits against cancer. The less processed the grains, the better. Diets high in refined starch and refined sugar may increase the risk of stomach cancer and bowel cancer.

Meat and bowel cancer
There is now convincing scientific evidence that eating processed meat increases bowel cancer risk. The World Cancer Research Fund (WCRF) has recently recommended that people avoid eating processed meat. Processed meats are any meat that has been preserved by curing, salting or smoking, or by adding chemical preservatives. These meats include hot dogs, ham, bacon and some sausages and burgers.

It is recommended that children are not given processed meats at all. This is because many of the habits we develop as children last into adulthood. Substitutes for processed meats that are recommended for children include poultry or fish, low fat cheese or small amounts of lean meat.

The WCRF also recommends limiting the amount of fresh red meat we eat to 500g (cooked weight) a week. This is because there is convincing evidence that red meat also increases a person’s risk of bowel cancer.

Some research suggests that eating burnt or charred meat may increase cancer risk, but the evidence is unclear.

Fats and cancer
There has been a great deal of interest in the possible association between fat and cancer. Current evidence does not indicate a direct link between fat intake and particular types of cancer (with the possible exception of prostate cancer). However, a high fat diet may lead to obesity, which is a risk factor for several cancers including cancer of the colon, breast, kidney, oesophagus, gallbladder and endometrium.

Supplements are not the answer
Results of studies that show a protective effect of foods containing certain nutrients should not be taken to mean that these nutrients, when isolated and taken as supplements, will provide the same benefits for cancer prevention. In some cases, there has been an increased risk of cancer in those people who take nutrient supplements at doses higher than the amount of that nutrient normally eaten in foods.

Suspect foods examined
While a high energy, low fibre diet may increase a person’s risk of developing cancer, some individual foods have also been singled out as potentially causing cancer (carcinogenic). These include:

• Artificial sweeteners – such as aspartame, saccharin and cyclamate. Laboratory rats can develop bladder cancer if fed huge amounts of saccharin or cyclamate, although this is at levels thousands of times greater than a normal diet. International studies agree that humans aren’t affected in the same way. Artificial sweeteners are considered safe to eat.

• Cured, pickled or salty foods – there is no conclusive evidence that red meat causes cancer. However, bacon and other cured or pickled meats contain a substance called nitrate, which has the potential to cause cancer in laboratory animals when eaten in huge doses. How this research relates to humans isn’t clear. To be on the safe side, it is best to limit the amount of cured meats in the diet because they are generally high in fat and salt. Salt has also been associated with an increased risk of stomach cancer and should be consumed in limited amounts.

• Burnt or barbecued foods – a group of carcinogenic substances called polycyclic aromatic hydrocarbons (PAHs) can be produced if foods are overheated or burnt. Although charred or smoked foods could contain traces of PAHs, experts agree that the amount in the average UK diet is too low to be considered a significant cancer risk. However, when cooking, it’s best to use relatively low temperature methods wherever possible. These include steaming, boiling, poaching, stewing, casseroling, braising, baking, stir-frying, microwaving or roasting. Avoiding char-grilled meats and foods would also be smart.

• Peanuts – some laboratory animals can develop cancer after eating peanuts that are contaminated with toxin-producing moulds. However, peanuts sold in the UK are generally uncontaminated and contamination is routinely screened for.

• Alcohol – consuming alcohol increases the risk of cancers of the mouth, pharynx, larynx, oesophagus, breast and liver. The risk is even greater in those people who smoke. Alcohol has also been associated with colon, breast and rectal cancers. Men should drink less than two standard drinks a day and women less than one standard drink a day.

Treating cancer with food
While food plays an important role in preventing some cancers, the therapeutic value of food in treating existing cancer is less clear. It is true that a person with cancer needs excellent nutrition in order to better cope with the physical demands of the illness and the rigours of medical treatment. However, claims that particular foods, vitamins or micro nutrients can kill cancer cells should be viewed with scepticism To date, there is little scientific proof that a particular food or supplement can cure cancer or destroy cancer cells.

Recently some Japanese studies have found that green tea may delay the development and spread of certain cancers. Other studies have suggested that soy may also have a similar effect. Although this work is preliminary, it may suggest a more important role for food in the treatment of cancer in the future.

Nutrition for the person with cancer is important for many reasons, including:

• The immune system needs bolstering to fight at full strength.

• The diet may be adjusted to cope with various symptoms, such as constipation, diarrhoea or nausea.

• Loss of appetite or an increased metabolism means that high energy foods may need to be included in the daily diet.

• Extra protein may be needed to help prevent loss of muscle from weight loss.

Things to remember

• High fat, low fibre diets may increase the risk of many cancers, including bowel, lung, prostate and uterine cancers.

• You can reduce your risk of developing cancer by eating more fresh fruits, leafy green vegetables and wholegrain foods.

• Even though diet can influence your risk of developing cancer, there is little evidence that special foods can be used to cure existing cancers.

Osteoporosis means ‘bones with holes’. Bones lose their strength and density, become fragile and break (fracture) more easily because of calcium loss. Breaks are most common in the spine, hip and wrist and often occur after only a minor fall or knock. Osteoporosis particularly affects women in their middle and later years, although some men are also affected.

Most people show no signs of developing osteoporosis until a fracture occurs. Both men and women can take steps from a young age to avoid developing the condition in later life. Reduce your risk of fractures by taking steps to prevent and treat osteoporosis (or brittle bones) and avoid falls wherever possible. Activity and a healthy diet rich in calcium and vitamin D are both important.

Osteoporosis and bone growth
Bone is formed by specialised cells. Like the rest of the body, bone is constantly being broken down and renewed. It is living tissue that needs exercise to gain strength, just like muscle. In the early years of life, more bone is made than is broken down, resulting in bone growth. By the end of your teens, bone growth has been completed and ‘peak bone mass’ is achieved.

Sex hormones, such as oestrogen and testosterone, have a fundamental role in maintaining bone strength in men and women. The fall in oestrogen blood levels that occurs during menopause results in accelerated bone loss. During the first five years after menopause, the average woman loses up to 10 per cent of her total body bone.

Fractures of the spine caused by osteoporosis can lead to loss of height, pain and changes in posture such as the ‘Dowager’s hump’. This hump is caused when spinal fractures are compressed due to the force of gravity, resulting in an abnormal bending of the spine (kyphosis).

Symptoms
Osteoporosis causes no specific pain or symptoms. However, it does increase the risk of serious or debilitating fractures. If you think you may be at risk of developing osteoporosis, see your doctor.

Risk factors for osteoporosis
Several factors can place a person at risk of osteoporosis. Risk factors include:

• Family history of osteoporosis (mother, sister or grandmother)

• Inadequate amounts of dietary calcium

• Low vitamin D levels

• Cigarette smoking

• Alcohol intake of more than two standard drinks per day

• Caffeine intake of more than three cups of tea, coffee or equivalent per day

• Lack of physical activity

• Early menopause before the age of 45

• Loss of menstrual period if it is associated with reduced production of oestrogen, which is vital for healthy bones (the menstrual cycle can cease following excessive dieting and exercise)

• Long-term use of medications such as corticosteroids for rheumatoid arthritis and asthma.

Some conditions place people at a higher risk of osteoporosis. These conditions include:

• Thyroid disease or an over active thyroid gland

• Rheumatoid arthritis

• Chronic liver and kidney disease

• Conditions that affect the body’s ability to absorb nutrients, such as Crown’s disease, coeliac disease and other inflammatory bowel conditions.

Preventing osteoporosis
Both men and women can take steps from a young age to prevent osteoporosis by making sure that they:

• Have a healthy and varied diet with plenty of fresh fruit, vegetables and whole grains

• Eat calcium rich foods

• Absorb enough Vitamin D

• Avoid smoking

• Limit alcohol consumption

• Limit caffeine

• Do regular weight bearing and strength training activities.

A varied and calcium rich diet is the key
We need calcium to build and maintain strong and healthy bones, help our muscles work and support our nervous system. Good sources of calcium include:

• Dairy foods – low fat varieties are available to reduce the risk of weight gain or raised cholesterol levels

• Canned fish with edible bones – for example, sardines.

The minimum recommended daily intake of dietary calcium is:

• Infants (under 12 months) – 210–270mg calcium per day

• Children (over four years) – 700–1,000mg calcium per day

• Adolescents – 1,300mg calcium per day

• Women under 50 and men under 70 – 1,000mg calcium per day

• Post menopausal women and men over 70 – 1,300mg calcium per day.

Adequate vitamin D
Vitamin D levels are increased with sun exposure. People who are housebound or who dress with most of their body covered are at risk of vitamin D deficiency. The majority of women have inadequate levels of vitamin D during winter months. All that is needed is 10–20 minutes of sun exposure to the arms and face daily, without sunscreen and not through glass. Sun exposure is safest before 11am or after 3pm.

Avoid smoking
Evidence has shown that smokers have a lower bone density. Nicotine is known to be toxic to bone cells.

Limit alcohol intake
Excessive alcohol consumption is associated with the development of osteoporosis. Restrict your alcohol intake to no more than two standard drinks on any one day for both men and women to reduce your risk. Everyone should have at least two alcohol-free days each week.

Reduce caffeine intake
A large amount of caffeine (more than two to three cups per day of cola, tea or coffee) has also been associated with an increased risk of osteoporosis.

Do regular weight bearing and strength training activities
You should exercise at least 30 minutes three to four times a week to maintain healthy bones. Recommended activities are:

• Walking

• Jogging

• Tennis

• Dancing

• Using weights.

This helps maintain bone strength and balance so falls are reduced.

Diagnosis
The most reliable way to diagnose osteoporosis is to measure bone density using a DEXA scan. This is done with x-ray technology that involves minimal radiation, is accurate and can be used to follow up treatment.

Ultrasound tests are available at many pharmacies and involve an ultrasound measurement of the heel. These tests are not as accurate in assessing for osteoporosis as a DEXA study and are not recommended by doctors.

It’s never too late for treatment
If you have osteoporosis, it is never too late to seek treatment. Treatment can halt bone loss and significantly reduce the risk of fractures. It is important that your doctor excludes other medical conditions that can cause osteoporosis, including vitamin D deficiency.

Medications and treatments are available to strengthen bones and prevent fractures by slowing down bone loss. They may improve bone density in women with osteoporosis after the menopause.

Available medical treatments include:

• Bisphosphonates – such as alendronate, risedronate and zolindrinic acid, which can be combined with vitamin D and calcium

• Strontium ranelate – also called Protelos

• Selective oestrogen receptor modulators (SERMs) – in the form of raloxifene

• Vitamin D derivatives and calcium supplements

• Hormone replacement therapy (HRT) – short-term use of oestrogen and progestogen at menopause.

Other potential therapies that may be used as treatment include parathyroid hormone.

Hormone replacement therapy
All treatments for osteoporosis aim to prevent fractures. Oestrogen replacement at menopause prevents bone loss and fractures, but the effect lasts only as long as oestrogen is used.

Oestrogen can be is used to prevent fractures mainly for younger women with premature menopause. This is because most fractures do not occur until after the age of 65 and long-term oestrogen use is not recommended.

Falls are a risk for people with osteoporosis
For people with osteoporosis, even minor trauma – such as coughing, knocks on the limbs and simple falls – can lead to fractures. Falls are a particular problem in the elderly as they are often more likely to result in fractures, particularly of the hip. Any fracture occurring from minimal trauma should be investigated as it may indicate underlying osteoporosis.

There are several ways to reduce your risk of falls. It may be necessary to see a physiotherapist and/or occupational therapist to provide assistance with walking aides and ensure your home environment is safe. Talk with your doctor or contact your community health centre to find the services you need.

Things to remember

• Osteoporosis occurs when bones lose their density and strength.

• A healthy lifestyle throughout life (adequate dietary calcium and regular physical activity) can help prevent osteoporosis.

• Oestrogen replacement helps maintain bone density in women with premature menopause.