How does one get cel­luli­tus? Keith Roach

Cape Breton Post - - ADVICE / TV HIGHLIGHTS -

DEAR DR. ROACH: What is cel­luli­tis, and how does one get it? I live in a re­tire­ment fa­cil­ity, and two ladies at my din­ing ta­ble have it. It seems to be very painful and dif­fi­cult to heal. Should I take any pre­cau­tions?— R.G.

AN­SWER: Cel­luli­tis is an in­fec­tion of the skin. It in­volves the full thick­ness of the skin, so it dif­fers from the re­lated in­fec­tion erysipelas, which is an in­fec­tion of just the outer layer.

Most cases of cel­luli­tis are caused by Strep­to­cocci, but Staphy­lo­coc­cus au­reus (“staph in­fec­tions”) are in­creas­ingly prob­lem­atic, es­pe­cially those caused by me­thi­cillin-re­sis­tant Staphy­lo­coc­cus au­reus, also called MRSA.

The big­gest risk fac­tor for de­vel­op­ing cel­luli­tis is a lack of skin in­tegrity. Trauma to the skin, such as a sim­ple abra­sion, a small cut or an in­sect bite, is a com­mon way for the bac­te­ria, which nor­mally live on (“col­o­nize”) the skin, to get through the skin bar­rier and cause an in­fec­tion. Skin con­di­tions such as eczema, or an in­fec­tion with, say, a fun­gus are other ways the bac­te­ria can get in. Chronic edema -- from heart, liver or kid­ney dis­ease, from lym­phedema or from med­i­ca­tions -- can cause small cracks in the skin that can’t be seen easily but that are large enough to al­low bac­te­ria to en­ter.

Cel­luli­tis can oc­cur any­where on the body, but it is most com­monly seen in the legs and feet. Hav­ing a weak­ened im­mune sys­tem -- from any cause, in­clud­ing dis­ease or treat­ments that af­fect the im­mune sys­tem -- pre­dis- poses one to de­vel­op­ing cel­luli- tis. Long­stand­ing di­a­betes, which af­fects small blood ves­sels, is another risk fac­tor. Just plain dry skin can cause sub­tle cracks. As the im­mune sys­tem tends to wane with age, ad­vanced age it­self is a risk.

Per­son-to-per­son trans­mis­sion of cel­luli­tis is very rare, since it is pre­dom­i­nantly some­thing about the per­son, not sim­ply ex­po­sure to the bac­te­ria, which is most im­por­tant in de­vel­op­ing cel­luli­tis. Proper skin care is the key for peo­ple at high risk, which in­cludes any­one with a history of cel­luli­tis as well as any­one with the risk fac­tors above. This means reg­u­lar ap­pli­ca­tion of mois­tur­iz­ers in peo­ple with dry skin, care­ful nail care, good footwear to pro­tect the feet from trauma and prompt care of any skin con­di­tion.

DEAR DR. ROACH: In a re­cent ar­ti­cle, you an­swered a woman in her 80s whose physi­cian was no longer or­der­ing mam­mo­grams or colono­scopies for her, and your re­sponse men­tioned a pos­si­ble risk of dam­age from colonoscopy. Can you clar­ify what you meant? All we hear is how im­por­tant they are and how pain­less the pro­ce­dure is, etc. — C.S.L.

AN­SWER: All med­i­cal pro­ce­dures have risk. The risk of a se­ri­ous com­pli­ca­tion from a colonoscopy is low, about 25 in 10,000 pro­ce­dures; that risk prob­a­bly is higher with ad­vanc­ing age. Even though 99.75 per­cent of peo­ple won’t have a se­ri­ous com­pli­ca­tion from a colonoscopy, I still think it’s im­por­tant to rec­og­nize that it has risks. How­ever, for most peo­ple be­tween 50 and 75, the ben­e­fits greatly out­weigh the risks.

One reader wrote in to ask me about CT colonog­ra­phy, some­times called a “vir­tual colonoscopy.” I think this tech­nique may re­place colonoscopy for some peo­ple. Per­haps even­tu­ally peo­ple will have a CT scan and, if an ab­nor­mal­ity is found, will go for a colonoscopy the same day to eval­u­ate the ab­nor­mal­ity. I don’t think the tech­nol­ogy is there yet to rec­om­mend this strat­egy, though.

READ­ERS: The book­let on her­pes and gen­i­tal warts ex­plains these two com­mon in­fec­tions in de­tail. Read­ers can ob­tain a copy by writ­ing: Dr. Roach – No. 1202, Box 536475, Or­lando, FL 32853-6475. En­close a check or money or­der (no cash) for $4.75 U.S./$6 Can. with the re­cip­i­ent’s printed name and ad­dress. Please al­low 4-6 weeks for de­liv­ery.

Dr. Roach re­grets that he is un­able to an­swer in­di­vid­ual letters, but will in­cor­po­rate them in the col­umn when­ever pos­si­ble. Read­ers may email ques­tions to ToYourGoodHealth@med.cor­nell.edu or re­quest an or­der form of avail­able health news­let­ters at P.O. Box 536475, Or­lando, FL 32853-6475. Health news­let­ters may be or­dered from www.rb­ma­mall.com. (c) 2015 North Amer­ica Syn­di­cate Inc. All Rights Re­served

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