Cellulitis is an infection of the skin. Facial cellulitis can be particularly dangerous because of the number of important structures in the face, like glands, eyes, mouth and nose. Children in particular are more susceptible to facial cellulitis because of their age, predisposition to trauma and number of infections in areas of the head, like sinuses, that can spread to the face.
Causes
Bacterial infection is the main culprit in the development of facial cellulitis. In children, bacteria can infect the face in several ways: as an infection that spreads from another area---for example, a bloodstream infection---or from sinusitis or other upper respiratory infections; from direct trauma to the area, which breaks down the skin barrier allowing bacteria to infect the area; or from insect bites and allergies that can cause itching and scratching, predisposing the child to a superimposed bacterial infection.
Symptoms
The main symptoms of cellulitis are redness and swelling of the affected site. In general, children have fever if other infections like sinusitis precede the development of cellulitis. The other symptoms of facial cellulitis vary depending on the area involved. For example, according to Medline Plus, children with cellulitis around the eye, or periorbital cellulitis, can exhibit severe swelling of the area surrounding the eye---so much so that the eye can be completely covered by the infected skin. Swelling of the lymph nodes of the neck is another symptom of facial cellulitis, as the lymph nodes become inflamed as the body tries to fight off the infection.
Diagnosis
The diagnosis of facial cellulitis relies mostly on a physical exam and the presence of swelling and redness of the affected area. Insect bite marks or other trauma can often be detected, as well. It is important to notice the functioning of the affected body part, for example if there is pain with movement of the eye or on opening the mouth. Bacterial cultures of the area can often identify the causative bacterium, which helps in the treatment of the infection. CT scans are helpful in identifying deeper infection, like sinusitis or an abscess, which could contribute to the facial swelling.
Treatment
Treatment of facial cellulitis relies on antibiotics. Initial therapy can be with oral antibiotics that combat the most common bacteria that cause these infections. In areas where methicillin-resistant Staphylococcus aureus, or MRSA, is prevalent, care must be taken to prescribe antibiotics that would eliminate this highly resistant bacterium. If outpatient oral antibiotics do not successfully treat the infection, or if there is a deeper infection like an abscess, then intravenous antibiotics should be used.
Warning
Children who have periorbital cellulitis should be closely examined to detect the presence of orbital cellulitis, a dangerous infection. According to the Merck Manuals, symptoms of orbital cellulitis include pain on eye movement, difficulty in visual acuity tests and popping out of the eye, a condition called proptosis. Children with orbital cellulitis need treatment with intravenous antibiotics and may require surgical intervention by an ophthalmologist.
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