Wednesday, February 22, 2012



This is by far and wide, the most common infection lymphedema patients experience.

Discussion Acute Cellulitis

Acute Cellulitis is one of the complications of lymphedema. The patient may not be aware of the source of the etiology. Sometimes it may be a cut, mosquito bite, open wound or other infection in the body.

The first sign is increased or different quality of PAIN involving the lymphedema limb. The patients often describe this as a "flu like symptom or an ache" involving the Lymphedema arm or leg. This is usually followed by sudden onset of ERYTHEMA (redness, red streaks or blotches) on the involved limb. The HYPERTHERMIA (lymphedema limb becomes warm, hot) will follow and the patient may experience the CHILLS and even HIGH FEVER.

The early intervention and treatment with antibiotics will resolve this condition (it usually takes a very minimum ten day course of antibiotics). Only a Medical Doctor will be able to prescribe the Antibiotics, thus a consultation with a Doctor is necessary. Severe Cellulitis may require Intravenous Antibiotic treatment and hospitalization. Again, elevation of the affected limb is important.

During that phase the patient should NOT massage the lymphedema limb, bandage, apply the pump, wear tight elastic sleeve or exercise excessively. Avoid the blood pressure and blood to be drawn from the involved arm. Keep the limb elevated as much as possible while resting. Once the symptoms dissipate the treatment MLD/CDP should be initiated.

How do we prevent this infection? The patient should be careful with daily activities and take all precautions to protect the skin (wear gloves when gardening, cleaning with detergents, etc... ). If an injury to skin occurs on the lymphedema limb it is necessary to clean the wound with alcohol or hydrogen peroxide and apply Neosporin/Polysporin antibiotic ointment. If the symptoms progress seek the attention of a physician immediately.

It is so very important to avoid getting cellulitus as it further destroys the lymphatic system. Allowed to spread or continue it can become systemic and can lead to gangrene, amputation of the limb or even death.

Risk Factors

Cracks or peeling skin between the toes

History of peripheral vascular disease

Injury or trauma with a break in the skin (skin wounds)

Insect bites and stings animal bites, or human bites

Ulcers from certain diseases, including diabetes and

vascular disease

Use of corticosteroid medications or

medications that suppress the immune system

Wound from a recent surgery



Cellulitis is clinically a spreading infection involving both the dermis and subcutaneous tissues. Unlike erysipelas, it will not have a clear raised border. Other features may include red streaking from the infected area, regional lymphadenopathy.


The basic way of diagnosing cellulitis is through a physical exam of the effected area, inconjunction with the above symptoms. Rememer, the area may be very red, warm to the touch, swollen and painful.

The doctor will also look for any cuts, scrapes, bites, ulcers or bruises, each is where bacteria could have entered the body.

Additional tests such as a blood test or culture may also be needed to determine the type of bacteria causing the infection.


Symptoms include all over body ache, fever, severe pain of the infected area, chills, weakness. The skin color will be red, warm and very tender to the touch.


The most common bacteria responsible for cellulitis infections are staph aureus and strep A. Other less common bacterial agents include Strep B, gram-negative bacteria, and immunocompromised patients pneumococcus. Less common bacteria such as Hemophilus influenzae, Pasturella multocide, and erysipelothrix rhusiopathiae can cause it as well.

Entry foci for the bacteria includes nasal cavities, wound, cuts, scrapes (any type of skin break). Insect bites (especially spider) can cause the condition. Cat scratches, animal bites are another source of bacteria.


Cellulitis responds well to antibiotic therapy. Generally, a ten day course of treatment is prescribed. Antibiotics used to treat cellulitis include Keflex, Augmentin, penicillins. Unasyn and vancomycin are standard IV antibiotics. In situations of a gram negative infection, Gentamicin is used. The types of antibiotic treatments include oral, topical (for a wound or skin cut) and intravenous antibiotics. Often it is only the IV antibiotic that can actually penetrate the fibrotic lympedema tissue to reach the bacteria.

For special at risk patients, blood work may also be indicated to assure the infection has not become systemic.

This group, which includes lymphedema patients may need extended IV antibiotic therapy. Lymphedema patients also need to elevate the effected limb, stop using compression garments and/or bandages until the infection has cleared.

See also: Lymphedema and Cellulitis

ICD9 - ICD10 - Related Resource Information

ICD-10L03. -
ICD-92008 ICD-9-CM Diagnosis 682.9

Cellulitis and abscess of unspecified sites

  • 682.9 is a specific code that can be used to specify a diagnosis
  • 682.9 contains 27 index entries
  • View the ICD-9-CM Volume 1 682.* hierarchy

682.9 also known as:

  • Abscess NOS
  • Cellulitis NOS
  • Lymphangitis, acute NOS

682.9 excludes:

eMedicinemed/310 emerg/88 derm/464

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