Cellulitis

Pathophysiology

Bacteria enter through a break in the skin barrier (even a tiny crack from athlete's foot)
S. pyogenes produces enzymes (hyaluronidase, streptokinase) that break down connective tissue, allowing rapid lateral spread
S. aureus tends to produce more localized infections (abscesses) but can also cause diffuse cellulitis
Infection spreads through dermis and subcutaneous fat along tissue planes
Complications: Abscess formation, bacteremia, sepsis, necrotizing fasciitis (rare but life-threatening)
Periorbital/orbital cellulitis: Medical emergency due to risk of intracranial spread

Rapidly expanding area of erythema with poorly defined, advancing borders
Warmth and tenderness to palpation. Pain disproportionate to appearance in early stages
Edema. Skin may appear taut and shiny from swelling
Red streaks (lymphangitis): Extending from the site — indicates lymphatic system spread
Fever, chills, malaise (systemic involvement)
Regional lymphadenopathy
Most commonly affects lower legs

Red streaks (lymphangitis): Critical red flag for systemic spread — immediate referral
Rapidly expanding redness with fever: Medical urgency requiring antibiotics
Distinguish cellulitis (spreading, poorly defined borders) from abscess (localized, well-defined)
Tinea pedis (athlete's foot): Common portal of entry for lower leg cellulitis
Periorbital cellulitis: Medical emergency — intracranial spread risk

Absolute contraindication: Do not massage any client with active cellulitis — risk of spreading infection through tissue planes
Urgent referral: If cellulitis is suspected during assessment (expanding redness, warmth, tenderness, fever), refer immediately
Red streaks = emergency: Lymphangitis indicates infection has entered the lymphatic system
Post-resolution: Once infection has fully resolved (antibiotic course completed, all signs gone), massage may resume normally
Prevention counseling: Clients with lymphedema or chronic venous insufficiency should maintain meticulous skin care
Comorbid awareness: Clients with diabetes, lymphedema, or immunosuppression are at highest risk for recurrence

Cellulitis is a rapidly spreading bacterial infection — absolute contraindication
Red streaks (lymphangitis) is a critical red flag for systemic spread
Distinguish cellulitis (spreading, poorly defined) from abscess (localized, well-defined)
Tinea pedis is a common portal of entry for lower leg cellulitis
Requires urgent medical referral — antibiotics are essential

Cellulitis is a rapidly spreading bacterial infection of dermis and subcutaneous tissue — a medical urgency
Most commonly caused by S. pyogenes or S. aureus entering through a skin barrier break
Red streaks (lymphangitis) indicate systemic spread and require immediate referral
Active cellulitis is an absolute contraindication to massage
Clients with lymphedema, diabetes, or immunosuppression are at highest risk