Aetiology

Cellulitis develops when micro-organisms gain entry to the dermal and subcutaneous tissues via disruptions in the cutaneous barrier. Beta-haemolytic streptococci and Staphylococcus aureus are most commonly implicated as the causative agents of cellulitis.[3][4][5][6][7][8][9][10][11][12][13][14] However, other micro-organisms can uncommonly result in cellulitis. Usually this occurs in a host with altered immunity or as the result of a specific exposure.

Pathophysiology

The pathophysiology of cellulitis has not been well studied. The burden of organisms in cellulitis appears to be low.[15] Some have speculated that the pyrogenic exotoxins produced by beta-haemolytic streptococci may contribute to the clinical findings in cellulitis.[16] There is evidence of local production of inflammatory cytokines by keratinocytes.[17] Interaction between surface proteins of Streptococcus pyogenes and adhesions on the surface of keratinocytes and Langerhans cells may be a requirement for infection to develop.[18] In many instances, tinea pedis may cause a disruption in the cutaneous barrier and allow entry to offending bacterial organisms.[19]

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