ance and symptoms. Usually no blood or other
laboratory tests are necessary, unless the doctor
suspects systemic infection (SEPTICEMIA) or ques-
tions the causative strain of bacteria.
Treatment Options and OutlookFor moderate, localized cellulitis the typical treat-
ment is a course of oral antibiotics with close fol-
low-up to make sure the selected antibiotic is
effective against the infection and the cellulitis is
improving. Warm, moist compresses over the
infected area help draw blood the area, improving
the body’s ability to fight the infection. When cel-
lulitis affects a large area or multiple areas or
worsens after antibiotic therapy begins, the doctor
may place the person in the hospital for intra-
venous (IV) antibiotic therapy and continuous
observation. Cellulitis in a person who is IMMUNO-
COMPROMISED or otherwise debilitated requires
especially aggressive treatment. Untreated or
undertreated cellulitis can have serious conse-
quences such as septicemia or GANGRENE(death of
the tissue). Cellulitis also presents particular risk
to people who have impaired circulation for any
reason. With timely and appropriate treatment,
most people recover fully.
Risk Factors and Preventive MeasuresWounds that break the skin breach the body’s first
line of defense against infection. Prompt cleansing
of the entry site with antibacterial soap and warm
water, followed with topical antibiotic ointment
and a bandage, helps reduce the amount of bacte-
ria that enter the skin and limit their ability to
cause infection. Early signs of infection, such as
swelling, redness, or drainage, require prompt
medical intervention that may include oral antibi-
otic medications. People who have diabetes, PVD,
and other conditions that restrict peripheral circu-
lation should develop the practice of regularly
examining the feet, lower legs, fingers, hands, and
lower arms for minor wounds that could become
problematic as a measure for early identification
and intervention to prevent cellulitis.
See also DECUBITUS ULCER; INSECT BITES AND STINGS;
NECROTIZING FASCIITIS.
chemical peel A cosmetic procedure to smooth
and tighten the surface of the SKIN, typically on
the face, to improve the appearance of WRINKLES,
scars, ACNE, widespread ACTINIC KERATOSIS, LENTIG-
INES(brown spots or liver spots), dyschromia (pig-
mentary irregularities), and other blemishes. The
dermatologist applies a chemical solution, either
an acid or phenol, to the selected areas of skin.
The solution BURNSthe skin, causing one layer or
more of skin to slough off as HEALINGtakes place.
The new skin that replaces the old skin is
smoother, tighter, and lighter in color.Light Peel: AHA Solutions
The lightest chemical peel is an alphahydroxyl
acid (AHA) solution such as lactic acid or glycolic
acid. It removes the top layer of skin (epidermis)
and is appropriate for treating minor skin irregu-
larities. The dermatologist puts the mild acid on
selected skin sites in a series of applications or may
mix the solution into a cream or wash for weekly
home use until the peel produces the desired
results. An AHA chemical peel causes mild irrita-
tion and discomfort that resolves as the skin heals.
It generally takes six to eight weeks to see results
with an AHA peel. An AHA peel requires frequent
retreatment to maintain the effect.Moderate Peel: TCA Solution
A moderate chemical peel uses a stronger acid
solution, trichloroacetic acid (TCA), to remove the
top and underlying layers of skin (epidermis and
upper dermis). The dermatologist applies the TCA
solution in one to three sessions spread over sev-
eral months. A TCA chemical peel is appropriate
for treating fine facial wrinkles and pigmentary
irregularities. The treated area first forms a frothy
coating and then scabs or crusts. The treated area
also becomes swollen and may be uncomfortable
enough to require mild PAINrelief medication for
several days. Full healing takes about two weeks.
The effects of a TCA peel generally last a year or
longer, though many people need more than one
treatment to achieve the desired results.Deep Peel: Phenol Solution
A deep chemical peel extends through the dermis,
the middle layer of the skin, to the hypodermis
(innermost layer of the skin). It produces some-
what of a burn effect that causes complete loss
and replacement of the skin. The dermatologist144 The Integumentary System