Topic Overview
What is cellulitis?
Cellulitis is a skin infection
caused by bacteria. Normally, your skin helps protect you from infection. But
if you have a cut, sore, or insect bite, bacteria can get into the skin and
spread to deeper tissues. If it is not treated with antibiotics, the infection
can spread to the blood or lymph nodes. This can be deadly.
Some
people can get cellulitis without having a break in the skin. These include
older adults and people who have
diabetes or a weak
immune system. These people are also more likely to
develop dangerous problems from cellulitis. And they are more likely to get
cellulitis again.
What causes cellulitis?
Cellulitis is caused by
bacteria (usually strep or staph). Some people are at risk for infection by
other types of bacteria. They include people with
weak immune systems and those who handle fish, meat,
poultry, or soil without using gloves.
What are the symptoms?
At first, the infected area
will be warm, red, swollen, and tender. As the infection spreads, you may have
a fever, chills, and swollen glands.
Cellulitis can occur anywhere
on the body. In adults, it often occurs on the legs, face, or arms. In
children, it is most common on the face or around the anus. An infection on the
face could lead to a dangerous eye infection.
See a doctor right
away if you have an infected area of skin and:
- The infected area is getting redder, more
painful, or larger, or it has red streaks extending from it.
- You
have a fever or chills.
- The infected area is on your face or your
groin.
How do you get cellulitis?
There are many ways to
get cellulitis. You can get it if you have:
- An injury to your skin, such as a cut,
surgical wound, burn, or animal or insect bite.
- Skin problems,
such as
ulcers,
eczema,
psoriasis, or a
fungal infection like
athlete's foot.
- Certain medical conditions. These include
diabetes,
peripheral arterial disease, or a weak immune
system.
- Fluid buildup (edema) in the
legs or arms.
- Had liposuction to remove excess fat.
- Injected
illegal drugs under your skin.
How is it treated?
Doctors use antibiotics to
treat cellulitis. If the infection is mild, you may be able to take antibiotic
pills at home. If the infection is severe, you may need to be treated in the
hospital with antibiotics that go right into your bloodstream.
If
your doctor prescribes antibiotics, it is important to take them as directed.
Do not stop taking them just because you feel better. You need to take the full
course of antibiotics.
It is very important to get treatment right
away for cellulitis. If it is not treated, the bacteria can spread quickly
through the body and cause
sepsis, an extreme response by the body’s defense
system. This can be deadly. Cellulitis on the face can spread to the brain and
cause a dangerous infection (meningitis). Cellulitis can also cause
other serious problems, such as blood clots in the legs (thrombophlebitis).
You are more likely
to have these problems if you are an older adult, have a medical condition such
as
diabetes or peripheral arterial disease, or have a
weak immune system. Your chances of the cellulitis coming back may be higher
too.
How can you prevent cellulitis?
If you are at
risk for cellulitis, you can take steps to help prevent it.
- Take good care of your skin. Keep it clean,
and use lotion to prevent drying and cracking.
- Check your feet and
legs often. This is especially important if you have diabetes.
-
Treat any skin infection, such as
athlete’s foot, right away.
- Ask your
doctor if you need to take antibiotics on a regular basis to prevent
cellulitis.
- If your doctor prescribes medicine, take it just the
way your doctor says to.
Frequently Asked Questions
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Symptoms
Symptoms of
cellulitis include tenderness, pain, swelling, and
redness at the site of infection. If the infection spreads, you may have fever
and chills, along with swollen
lymph nodes. Sometimes, if cellulitis causes a high
fever, you may have changes in mental function, such as confusion or
sleepiness. Cellulitis can occur anywhere on the body, most often on the legs,
face, or arms. Although the infection is not usually severe in adults, in some
cases it can spread quickly, causing more intense symptoms.
Symptoms in infants and children
In children,
cellulitis often affects the face, legs, arms, or the area around the anus.
Swelling and redness are often widespread and lack distinct borders.
In infants, cellulitis can be serious because their
immune systems cannot protect them from infection.
Symptoms in adults
In adults, cellulitis typically
develops near a surgical site or at the site of an injury, such as a burn, a
cut, or an animal bite. It usually affects the legs but can occur on other
areas of the body, such as the face and ears. Pain and tenderness may be the
first signs of cellulitis before visible signs of infection appear.
Cellulitis often comes back (recurs), especially if you have a weakened
immune system or a condition that affects the health of your skin, such as a
fungal infection or
diabetes. Recurrence is also more common if you have
problems with your blood circulation or with the
lymphatic system, which drains fluids from your
tissues. Recurring infection in the legs can cause a condition called
elephantiasis, an enlargement of the skin on the legs and tissues in the legs.
Other conditions with similar symptoms (such as pain, swelling,
and redness) include
contact dermatitis and
shingles.
Symptoms of cellulitis in the eye area
If
cellulitis affects the eye area, you may have pain in and around the eye,
restricted eye movement, and disturbances in your vision. Cellulitis affecting
the eye requires urgent treatment to prevent permanent eye damage, blindness,
or spread of the infection to the brain (meningitis).
Exams and Tests
Doctors often diagnose
cellulitis by looking at your symptoms. In most cases,
you won't need further testing, and your doctor will prescribe
antibiotics.
Sometimes
ultrasound will be used to make sure there is not a
blood clot in a deep vein. A
CT scan or an
MRI may also be done to rule out other
problems.
If the initial treatment with antibiotics is not
effective, your doctor may take samples of your blood and skin to identify the
specific bacteria present so he or she can select a more effective antibiotic.
Other lab tests usually are not helpful unless bacteremia (bacteria in the
blood),
sepsis, or another disease is suspected.
Treatment Overview
The intent of
cellulitis treatment is to decrease the severity of
the infection, speed up recovery, relieve pain and other symptoms, heal the
skin, and prevent the infection from coming back.
Antibiotics
are usually used to treat cellulitis. If
the infection is limited to a small area, has not spread to the bloodstream or
lymph system, and you don't have any other medical
problems, antibiotics you take by mouth (oral) are effective. If the infection
is more widespread, or if you're having a slow recovery on oral antibiotics,
antibiotics may be used
intravenously (IV) or by injection.
For
cellulitis of the leg or arm, treatment also includes elevating the limb to
reduce swelling.
Treatment for children depends on their age and
which part of the body is infected. An antibiotic is usually given
intravenously. Facial cellulitis in young children requires immediate treatment
and responds well to antibiotics.1
Treatment sometimes requires a stay in the hospital. This is common if
antibiotics must be given intravenously. But a hospital stay is also considered if you have
signs of complications such as a high fever or if it will be hard for you
to have follow-up care with a doctor.
Medicines used to treat cellulitis
Oral, topical
(applied to the skin), or intravenous antibiotics may be used to treat
cellulitis. The extent of the infection and its location help determine what
type of antibiotic is used.
-
Oral antibiotics include penicillin, cephalexin, or cefaclor. For people who are allergic to penicillin, a
cephalosporin or erythromycin can be used.
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Topical antibiotics (antibiotics that you spread on the skin) may be
used to treat mild cellulitis in some cases.
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Intravenous (IV) antibiotics or antimicrobials may be used if the cellulitis is spreading quickly or you have a weakened immune system or a condition like diabetes.
Preventing a recurrence of cellulitis
Cellulitis
tends to recur in people who have certain medical conditions that can lead to skin
breakdown, such as
edema (fluid buildup), fungal or bacterial infections,
diabetes, or
peripheral arterial disease.
- If you have edema, support stockings and good
skin hygiene may reduce or eliminate recurrence of cellulitis.2
- If you have frequent fungal infections, regular
use of antifungal medicines may help reduce recurrent
cellulitis.
- If you are considered very high risk for recurring
cellulitis, taking preventive antibiotics may help.
Home Treatment
If you have
cellulitis, follow your doctor's instructions about
medicine and skin care. Other steps to help your recovery and keep cellulitis
from coming back include the following:
- Take all of your medicine as
prescribed.
- Take care of your skin. Any measure that prevents
injury to your skin will help to prevent cellulitis. Use moisturizers to keep your skin from becoming dry and cracked.
- Elevate your
affected leg or arm to reduce swelling.
- Apply warm compresses to
the affected area.
- Use pain relievers as needed.
- Use
support stockings to prevent fluid buildup.
- Take steps to treat or
prevent fungal infections, such as
athlete's foot. If athlete's foot is hard to treat or
recurs, ask your doctor about oral antifungal medicines. For more information
on treating this condition, see the topic
Athlete's Foot.
- Take care of your feet,
especially if you have
diabetes or other conditions that may increase the
risk of infection.
- Avoid touching possible sources of infection,
such as ill family members and their belongings; raw fish, meat, or poultry; or
soil, particularly when you have an area of broken skin.
One study found that inflammation caused by toes rubbing
together (toe-web intertrigo) may be a cause of cellulitis in the leg. This
study showed that treating this skin inflammation could prevent
cellulitis.3
When you have completed your
course of medicine, follow up with your doctor to verify that the infection is
gone.
Other Places To Get Help
Organizations
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American Academy of Dermatology
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| P.O. Box 4014 |
| Schaumburg, IL 60168 |
| Phone: |
1-866-503-SKIN (1-866-503-7546) toll-free (847) 240-1280 |
| Fax: |
(847) 240-1859 |
| Web Address: |
www.aad.org |
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The American Academy of Dermatology provides information
about the care of skin, hair, and nails. You can find a dermatologist in your
area by calling 1-888-462-DERM (1-888-462-3376).
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National Institute of Allergy and Infectious Diseases
(NIAID), National Institutes of Health
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| NIAID Office of Communications and Public Liaison |
| 6610 Rockledge Drive, MSC 6612 |
| Bethesda, MD 20892-6612 |
| Phone: |
1-866-284-4107 toll-free (301) 496-5717 |
| Fax: |
(301) 402-3573 |
| TDD: |
1-800-877-8339 |
| Web Address: |
www3.niaid.nih.gov |
| |
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The National Institute of Allergy and Infectious
Diseases conducts research and provides consumer information on infectious and
immune-system-related diseases.
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References
Citations
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Lin Y-TJ, Lu P-W (2006). Retrospective study of
pediatric facial cellulitis of odontogenic origin. Pediatric Infectious Disease Journal, 25(4): 339–342.
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Pasternack MS, Swartz MN (2010). Cellulitis, necrotizing fasciitis, and subcutaneous tissue infections section of Skin and soft tissue infections. In GL Mandell et al., eds., Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 7th ed., vol. 1, pp. 1289–1312. Philadelphia: Churchill Livingstone Elsevier.
-
Saavedra A, et al. (2008). Soft-tissue infections:
Erysipelas, cellulitis, gangrenous cellulitis, and myonecrosis. In K Wolff et
al., eds., Fitzpatrick's Dermatology in General Medicine, 7th ed., vol. 2, pp. 1720–1731. New York: McGraw-Hill
Medical.
Other Works Consulted
- Heagerty AHM (2010). Cellulitis and erysipelas. In MG Lebwohl et al., eds., Treatment of Skin Disease: Comprehensive Therapeutic Strategies, 3rd ed., pp. 132–134. Edinburgh: Saunders Elsevier.
- Morris AD (2008). Cellulitis and erysipelas, search
date May 2007. Online version of BMJ Clinical Evidence:
http://www.clinicalevidence.com.
- Saavedra A, et al. (2008). Soft-tissue infections:
Erysipelas, cellulitis, gangrenous cellulitis, and myonecrosis. In K Wolff et
al., eds., Fitzpatrick's Dermatology in General Medicine, 7th ed., vol. 2, pp. 1720–1731. New York: McGraw-Hill
Medical.
Credits
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By
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Healthwise Staff |
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Primary Medical Reviewer
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Kathleen Romito, MD - Family Medicine |
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Specialist Medical Reviewer
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Alexander H. Murray, MD, FRCPC - Dermatology |
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Last Revised
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February 14, 2011 |
Lin Y-TJ, Lu P-W (2006). Retrospective study of
pediatric facial cellulitis of odontogenic origin. Pediatric Infectious Disease Journal, 25(4): 339–342.
Pasternack MS, Swartz MN (2010). Cellulitis, necrotizing fasciitis, and subcutaneous tissue infections section of Skin and soft tissue infections. In GL Mandell et al., eds., Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 7th ed., vol. 1, pp. 1289–1312. Philadelphia: Churchill Livingstone Elsevier.
Saavedra A, et al. (2008). Soft-tissue infections:
Erysipelas, cellulitis, gangrenous cellulitis, and myonecrosis. In K Wolff et
al., eds., Fitzpatrick's Dermatology in General Medicine, 7th ed., vol. 2, pp. 1720–1731. New York: McGraw-Hill
Medical.