Here’s how even small cuts from cycling or stepping in puddles could land you in hospital

If you are into bouldering, cycling, racquet sports, running or any other form of exercise, chances are, you’ve had your fair share of minor wounds such as abrasion, blisters and cuts. But what’s the big deal, you ask. You simply wipe off the blood, slap on a plaster and get on with your workout. No one has ever died from these trivial injuries, you say.

For one, such injuries could potentially land you in hospital as these open wounds are like putting out the welcome mat for bacteria to enter your body. Once in, infection-causing pathogens can create a situation known as cellulitis.

Two, cellulitis can progress to necrotising fasciitis of the affected limb, which is tissue death, in rare and extreme cases, said Dr Pan Jiun Yit, a senior consultant with National Skin Centre.

According to Dr Teo Cheng Rong, a family physician with Healthway Medical Group, most cases of cellulitis are caused by bacteria such as Group A streptococcus or Staphylococcus aureus. And it’s not just cuts and scrapes. “They manage to enter the skin when there is a break in the skin barrier, for example, from scratching and insect bites.”

That also applies to stepping into puddles of dirty water – of which there are plenty from the recent incessant rain. “Puddles of water, especially if left to collect over a period of time, could harbour microorganisms such as bacteria that can cause cellulitis,” said Associate Professor Nisha Suyien Chandran, a senior consultant and head of Division of Dermatology in National University Hospital’s (NUH) Department of Medicine.

And if you need another reason not to break your blister, Dr Saw Yu Ting, a surgically trained podiatrist with Straits Podiatry, a member of Healthway Medical Group, has one. “The risk of developing cellulitis in this scenario is only increased if you have an open wound or skin break such as broken blisters on the foot, ankle or leg,” she said.

“If the blister that is formed from wearing poor-fitting shoes is well and intact, no bacteria will enter the body and cause an infection.”

WHAT ARE THE SIGNS OF CELLULITIS AND HOW COMMON IS IT?

Cellulitis is an infection of the skin and potentially, its deeper structures, said Dr Teo. “During the infection, the skin may appear red, swollen with an ‘orange peel’ look, and feel warmer than the surrounding normal skin.”

The “muscle soreness” from cellulitis could potentially be confused for post-workout delayed onset muscle soreness (DOMS). But, in cellulitis, there are other accompanying symptoms, including fever, chills and malaise, said Assoc Prof Chandran. “Blisters may occur on the skin if the infection and inflammation are more superficial.”

How often do doctors see this bacterial infection in Singapore? “Often, up to a few times a week,” said Dr Pan, with severe cases requiring hospitalisation and intravenous (IV) antibiotics. For general practitioners such as Dr Teo, he sees “at least one or two cases of cellulitis per month”.

Over at the A&E department, Assoc Prof Chandran said that cellulitis is a common cause for emergency visits and inpatient care. “Over the past few years, the Department of Medicine at NUH has admitted an average of 300 to 400 patients annually for cellulitis.”

But before you start dousing a scratch with iodine solution, it is likely that those with an immunocompromised state would be prone to cellulitis, said Assoc Prof Chandran, including patients with cancer, Aids, certain genetic disorders, chronic diseases such as diabetes or chronic kidney disease, and those who have received organ or stem cell transplants.

Those with localised skin conditions such as eczema, psoriasis, fungal skin infections, chronically dry skin, nail infections, and vascular disease that causes poor blood circulation in the affected site are also prone to cellulitis, she said.

HOW IS CELLULITIS TREATED?

There is no need for hospitalisation if cellulitis is detected early, not severe and the patient doesn’t have any risk factors, said Assoc Prof Chandran.

“Oral antibiotics, instead of IV antibiotics, can be used if there is no extensive or rapidly progressing redness, the patient does not show signs of severe disease such as fever, hypotension (low blood pressure), tachycardia (increased heart rate), or if the patient is not immunocompromised. The patient must also be able to tolerate medication orally,” she said.

Added Dr Pan, “milder cases can be treated at your local GP or polyclinic with antibiotics and rest at home”, who advised to give it one to two weeks for the oral antibiotics to kick in. “If the redness, swelling, fever and pain persist beyond two weeks, see a doctor again.”

Dr Teo highlighted that you should also make a trip to the doctor’s if “the area of cellulitis expands rapidly or does not reduce after taking oral antibiotics”.

As a gauge, the symptoms should show improvement within 24 to 48 hours of taking the oral antibiotics, said Assoc Prof Chandran. “Skin signs may take longer to manifest, sometimes more than 72 hours. We like to see redness, warmth and swelling reduce. If these do not, seek medical attention.

“If cellulitis is not controlled locally at the affected site, the bacteria can spread into the bloodstream. This can cause organ dysfunction of varying extent,” said Assoc Prof Chandran.

CAN’T THESE MINOR ABRASION AND CUTS WAIT?

Many of us are guilty of not tending to minor injuries such as skin abrasion and superficial cuts because we deem them as small incursions. However, “continuing the activity without tending to it may cause further contamination”, said Assoc Prof Chandran.

Jackie Tey, a podiatrist from Straits Podiatry, advised to stop and look after the wound as soon as possible. “One should always clean the wound with running water and cover it with a dressing such as plasters. This will prevent bacteria from multiplying in the wound and causing further infections.”

Better a plaster than a needle in your arm at the hospital.