DRHOOK- Cellulitis: Painful rash makes sufferers see red

the handsome doctor John Hong of Charlottesville

Red is a bold color. You have to be brave to wear an all-red outfit. How many men have you seen wear a red suit, besides The Joker and Elton John? 

I wear red ties. I don't have any red pants or shirts. Shoe colors are "cordovan" or "ox blood," but not red. Better dead than red?

 What happens if your skin is red?

 Cellulitis and erysipelas are two types of relatively common skin infections. Bacteria infect the skin and cause redness, heat, and swelling that can be painful. Erysipelas occurs more often in kids, and cellulitis in adults. Strep and staph are usually the bad boys of these skin infections.

 "Butterfly" is a rap song that I cannot do justice to on my karaoke machine. Well, erysipelas on the face kind of looks like a butterfly, affecting the forehead, nose, and cheeks. But erysipelas doesn't flow like a butterfly. It spreads like wild fire, causing a raised, swollen, well-demarcated rash. 

 Fever, chills, and just feeling ill often occur with erysipelas, but usually not with cellulitis. 

 Cellulitis is a deeper skin infection that goes down to the fat layer. It doesn't spread as fast as erysipelas, usually over only a few days. Pus doesn't build up underneath like in an abscess (which would then require draining for treatment). Cellulitis around the eye can be very serious, requiring IV antibiotics to prevent vision problems and even death. (Talk about an eye sore– whew!)

 Swelling makes the skin feel firm– and even look firm– like an orange peel (although you aren't going to get any Tropicana Pure Premium out of this). The hair follicles can look dimpled if the swelling is significant enough. If you push down the red skin with your finger, it might blotch pale and then turn back to red. Blisters and small bruises can form as well.

 However, if you push down on the red area, and underneath it feels like Rice Krispies (from air bubbles underneath), that can be a bad, bad– did-I-say-bad?– sign of gangrene. 

 You know how some people just "get under your skin"? Bacteria do as well, in particular the skin of folks who have a puncture wound. Broken open skin is a portal for infection. I always tell my patients with chronic athletes foot or chronic jock itch to spray anti-fungals— not for cosmetic reasons, but because cellulitis can start between the fungus-infested toes that makes toe jam turn to toe jelly.

 A swollen head is never good, and neither are swollen legs. It seems with increasing levels of obesity, more folks have leg swelling from varicose veins. Swelling can cause skin to breakdown and get rashes, and lead to cellulitis. Big bellies and breasts can cause moisture to build up under skin folds so that skin ulcers and infections can pop up.

 Topical antibiotics, like Polysporin, can help prevent a molehill from becoming a mountain. Taking care of wounds by keeping them clean can make a big difference. However, if all else fails, oral antibiotics usually work pretty darn well.

 Red lips and rosy cheeks are very nice, in particular on runway models. But red infected skin can really leave you off color.


Dr. Hook cracks a joke or two, but he's a renowned physician with a local practice and an interesting website, drjohnhong.com. Email him with your questions.