Cellulitis is a bacterial infection of the skin and of the soft tissue underlying the skin. The infection is usually caused by staphylococci (“Staph”) or streptococci (“Strep”) bacteria that are commonly found on the skin of healthy individuals. These bacterial are also found inside the nose or mouth and can be a source of recurrent infections. When there is a break in the skin from trauma or another viral or fungal infection, bacteria can enter skin and cause redness and swelling typically seen in cellulitis.

Most cases of cellulitis are self-limited and mild in severity. Oral antibiotics can clear the skin infection completely. However, some cases are severe and can cause a generalized infection. It is important to seek medical care immediately for worsening symptoms, fevers, rapid growth of redness and swelling around infected area, pain, or loss of sensation of skin. Certain individuals are at increased risk for complications and must seek care promptly.

What are the risk factors for cellulitis?

● Injury to the skin from a wound, cut, shaving, injection, abrasion, or drug abuse

● Prior radiation treatment to the area

● Co-existing fungal or viral skin infection, such as athlete’s foot, molluscum, or chickenpox

● Swelling or accumulation of fluid due to poor circulation (edema), heart failure, liver disease, or past surgery to remove lymph nodes causing lymphedema

● A person who is obese or overweight

● Poorly controlled skin conditions like eczema

Cellulitis can still develop without any known risk factors.

What are the symptoms of cellulitis?

Development of cellulitis can be gradual or sudden. The most common symptoms are redness, warmth, swelling, and pain or tenderness over a defined area. The usual sites of involvement are shins, arms, around the eye, breasts, and the abdominal wall. The redness may expand over a matter of hours or days, indicating rapid progression of infection. Itching is not a typical symptom and can be used to distinguish cellulitis from other non-infectious causes of localized redness and swelling. The skin overlying cellulitis is usually smooth and shiny, helping to distinguish the infection from stasis dermatitis in which the skin is usually raised or bumpy. However, with intense inflammation in cellulitis, small blisters or bumps might appear.

Treatment of Cellulitis

Antibiotics: Treatment for cellulitis starts with a course of oral antibiotics for 5-14 days. Sometimes changes to the antibiotic regimen are necessary if there is no improvement or if there is worsening of symptoms. Delays in seeking medical care or use of wrong treatment can worsen the infection. It is important to take the antibiotic with prescribed instructions and for the entire duration. Incomplete treatment with skipped doses or shorter duration can cause bacterial resistance and worsen the infection. Sometimes, cellulitis can worsen despite appropriate oral antibiotics and might require intravenous antibiotics during hospitalization.

Elevation: Elevating arms and legs with extra pillows to above the level of the heart can help reduce swelling and speed up healing.

Skin Care: It is important to keep the infected area clean and dry. Use gentle cleansers and cleanse regularly, especially for wounds with a lot of drainage. Avoid using a loofa or other mechanical tools for cleansing as they can cause more skin injury. Dry gently using a patting motion with your towel. You can use gauze to catch any drainage or bandage to protect the skin if needed. Improvement in swelling, redness, warmth, and fevers and chills should occur within one to three days after starting antibiotic therapy. Skin symptoms can last for up to two weeks before resolving completely. Cellulitis is not highly contagious to other family members, but it is important to wash hands regularly and to avoid sharing towels.

Depending on your signs and symptoms, our dermatologists can help determine the right treatment option for you.