What Is Cellulitis?

Cellulitis is a bacterial infection affecting the inner layer of your skin and underlying tissue. It is a common skin condition, with more than 14 million cases reported in the United States each year. Cellulitis often appears as an area of skin that is red, warm, swollen, and tender. It is common on the legs and feet but can be found anywhere. Your healthcare provider may be able to give you a diagnosis right away, but some are referred to specialists, such as a dermatologist, to ensure an accurate diagnosis.

The infection occurs when bacteria is able to enter the skin through an area of breakdown like a scratch, burn, or bite. People at risk for skin injuries as well as middle-aged and older adults are at a higher risk of developing cellulitis. Although it can be a painful condition with risks for complications, it is usually easily treated with antibiotics and rarely needs further intervention.

Cellulitis Symptoms

Cellulitis typically presents as patches of redness, warmth, swelling, or tenderness of the skin. While not everyone with cellulitis experiences all these symptoms, at least two need to be present in order to make a diagnosis. You may also develop blisters over the affected area or something called peau d'orange, which is where your skin may become dimpled and pitted to look like the peel of an orange. You may experience whole-body symptoms of infection, too, such as running a fever and chills.

You can get cellulitis anywhere on your body, but it is most common on the legs and feet. As this infection is caused by bacteria, you may notice it developing around a place bacteria could get in such as near an injury or bug bite.

Cellulitis can be painful, but if your pain increases intensely all of a sudden or goes numb this could be a sign of compartment syndrome, which is a medical emergency. Compartment syndrome occurs when pressure inside the muscles builds to a dangerous level. Seek medical help right away if you think this is occurring.

What Causes Cellulitis?

Cellulitis is an infection caused when bacteria get into the inner layer of skin and the tissue beneath it and begin multiplying. Your immune system reacts in order to get rid of this infection and the inflammation of this process causes many of the symptoms of cellulitis.

Cellulitis is most commonly caused by group A streptococcus bacteria though it is also known to be caused by methicillin-resistant Staphylococcus aureus (MRSA). Cellulitis is sometimes caused by other bacteria, particularly when someone has certain risk factors like having a compromised immune system. Any injury or act that breaks the skin could potentially cause cellulitis, but this is especially true when the cause of the skin break exposes you to a lot of bacteria such as with an animal bite or injecting with a used needle.

People get nicks and breaks in their skin all the time and do not develop cellulitis. This is because our bodies are usually able to fight off any bacteria that enter there. Some things that increase your chances of developing cellulitis include:

• Being 50 years of age or older
• Having poorly controlled diabetes mellitus
• Having athlete's foot (also called tinea pedis) or eczema (also called atopic dermatitis)
• Taking medications that suppress the immune system
• Having human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS)
• Having long-term kidney or liver disease
• Having lymphedema (swelling due to excess lymph fluid in your body)
• Having poor circulation
• Injecting IV drugs
• Being an athlete
• Being active duty military
• Being in prison
• Living in a long-term care facility

Diagnosis

Your healthcare provider may be able to diagnose cellulitis just from the appearance of your affected skin. They will also ask you some questions to help determine if it is cellulitis and what might have started the infection. If you had an injury or bite around the affected area, be sure to mention that in your appointment.

Additional testing like imaging or blood tests are generally not recommended for diagnosing cellulitis. However, your provider may run some tests to determine what type of bacteria is causing the infection in order to know how to treat you.

If your healthcare provider is not sure about your diagnosis, they may refer you to a dermatologist. Dermatologists are medical doctors who specialize in the skin, hair, and nails. Cellulitis can look similar to other skin conditions, so seeing a dermatologist can help you make sure you are getting an accurate diagnosis.

Treatments for Cellulitis

The most common treatment for cellulitis is a course of antibiotics. The vast majority of people will only need antibiotics in tablet or capsule form. Occasionally, for severe cellulitis or cellulitis affecting the face, your provider may recommend a course of intravenous (IV) antibiotics. In these cases, people typically stay in the hospital while they are treated. Most patients are in the hospital for less than two weeks before returning home.

If you have a wound or medical condition that caused cellulitis, treating those things will be important for preventing your infection from getting worse as well as preventing cellulitis in the future.

If the cellulitis is in your leg, elevating it on a cushion or stool can reduce swelling, which reduces pain and helps your body heal. Getting plenty of rest is also important while your body is fighting off the infection.

Surgery is not usually necessary to treat cellulitis, but there have been instances where surgical intervention has been beneficial, particularly in aggressive or fast-moving infections.

Prevention

While cellulitis can be a painful disease, it is also largely preventable. Some ways to prevent cellulitis include:

• Take precautions to avoid injuring your skin: This can include things like wearing gloves when gardening or working with tools and wearing sunscreen to prevent sunburns.
• Attend to any wounds right away: Wash the affected area with soap and water, apply antibiotic ointment if you have it, and cover it with a bandage. If the injury is deep or long, check in with your healthcare provider about treatment.
• Take care of your skin: Wash your hands frequently to lower the presence of harmful bacteria on your skin. Moisturizing your skin at least daily will help to keep it healthy and prevent any cracks from forming where bacteria could get through.
• Treat conditions that make it more likely you will develop cellulitis: This includes treating any infections as they develop.
  

Complications

Complications, or medical issues that arise as a result of cellulitis, are not common. When they do happen, though, they can be serious concerns. Many of these complications are severe infections that spread to other areas of the body. Some of these include:

• Bacteremia, which is when bacteria is present in the bloodstream
• Osteomyelitis, which is inflammation of the bone or bone marrow
• Endocarditis, which is inflammation of the heart's inner lining and valves
• Infections in the bone joint

Living with Cellulitis

Most people with cellulitis recover quickly after beginning antibiotic treatment. Depending on where the infection is and its severity, some people may take longer to recover or need some time in the hospital.

Approximately 18% of people cannot get rid of the infection after the first antibiotic treatment, so if you do not feel better after 24-48 hours of starting treatment, reach out to your healthcare provider to let them know.

People who have had cellulitis in the past are at higher risk of getting it again than people who have never had cellulitis. Fortunately, taking steps like protecting your skin and using good hygiene can go a long way to preventing it from returning.