Cellulitis Overview - eMedicine Health

Cellulitis is a common infection of the skin and the soft tissues underneath the skin. It occurs when bacteria invade broken or normal skin and start to spread just under the skin or in the skin itself. This results in infection and inflammation. Inflammation is a process in which the body reacts to the bacteria. Inflammation may cause swelling, redness, pain, or warmth.

People at risk for getting cellulitis include those with trauma to the skin or other medical problems such as the following:

Diabetes
Circulatory problems such as inadequate blood flow to the limbs, poor venous or lymphatic drainage, or varicose veins
Liver disease such as chronic hepatitis or cirrhosis
Skin disorders such as eczema, psoriasis, or infectious diseases that cause skin lesions such as chickenpox or severe acne

Cellulitis Causes

Injuries that break the skin
Infections related to a surgical procedure
Any breaks in the skin that allow bacteria to invade the skin (examples are chronic skin conditions such as eczema or psoriasis)
Foreign objects in the skin

Cellulitis Symptoms

Cellulitis can occur in almost any part of the body. Most commonly it occurs in areas that have been damaged or are inflamed for other reasons, such as inflamed lesions, contaminated cuts, and areas with poor skin condition or bad circulation. The common symptoms of cellulitis are as follows:

Redness of the skin
Red streaking of the skin or broad areas of redness
Swelling
Warmth
Pain or tenderness
Drainage or leaking of yellow clear fluid or pus from the skin
If the condition spreads to the body via the blood, then fevers and chills can result.
Infection of bone underneath the skin (An example is a long-standing open wound that is deep enough to expose the bone to bacteria. Sometimes this occurs in people with diabetes who cannot feel their feet.)

When to Seek Medical Care

Call your doctor if you have any of the following signs or symptoms of cellulitis:
Fevers or chills
Redness on the skin
Red streaks from skin
Increased warmth
Swelling
Tenderness
Drainage from the skin

Go to the hospital's emergency department if you have any signs or symptoms of cellulitis, especially the following:

High fevers or chills
Nausea and vomiting
Obvious enlargement or hardening of the reddened area
Increasing pain
Numbness of the reddened or tender area when touched
Other medical problems that may be affected by even a minor infection

Exams and Tests

Most likely the doctor will make the diagnosis from a medical history and physical examination.

The doctor may also draw blood for testing if he or she feels the infection is severe enough to be in the bloodstream.

The doctor also may order an x-ray of the area if there is concern that a foreign object is in the skin or that bone underneath is infected.

The doctor may try to draw fluid from the affected area with a needle and send the fluid to the laboratory for a culture.

Cellulitis Treatment

Self-Care at Home

Rest the area of the body involved.

Elevate the area of the body involved. This will help decrease swelling and relieve discomfort.

Use over-the-counter pain relievers such as acetaminophen (Tylenol) or ibuprofen (Motrin). This will decrease the pain as well as help keep the fever down.

Medical Treatment

If the infection is not too severe you can be treated at home. The doctor will give you a prescription for antibiotics to take by mouth for a week to 10 days.
The doctor may use intravenous (IV) or intramuscular antibiotics in these situations:
If the infection is severe
If you have other medical problems
If you are very young or very old
If the cellulitis involves extensive areas or areas close to important structures like infection around the eye socket
If the infection worsens after taking antibiotics for 2-3 days

You may need hospitalization if the infection is well developed, extensive or in an important area, like the face. In most of these cases, IV antibiotics need to be given until the infection is under good control (2-3 days) and then you can be switched to oral medications to be taken at home.

Medications

Antibiotics are prescribed by mouth or by injection. Be sure to tell your doctor about any reactions you may have had in the past to antibiotics.

Surgery

Rarely, severe infection may need surgery.
An abscess, or collection of pus in the tissue, may need to be opened surgically to allow drainage.
Dead tissue may need to be cut away to allow healing.

Follow-up

Once you leave the doctor's office, be sure to take all the antibiotics prescribed. The doctor may want to see you in 2-3 days to see if the cellulitis is improving.

Prevention

It is very important to keep your skin clean by practicing good personal hygiene.

If you notice pain or discomfort from an area of the skin, check to see what it looks like. If it appears inflamed and progresses from one day to the next, you will most likely need treatment.

Avoid situations that may injure your skin, especially if you have swelling from circulatory problems.

Wear sturdy, well-fitting shoes or slippers with loose-fitting cotton socks.

Avoid walking barefoot in areas where you do not have a good idea about what you are walking on, for example, in garages, on a littered beach, or in the woods.

If you do injure your skin wash the area with soap and water and check to make sure that the injury is getting better over the next several days.

Certain injuries may be at greater risk for infection than others. You may need to take antibiotics to prevent infection or have other preventive care. Be sure to contact your doctor if you have injuries such as these:

*Animal or human bites

*Puncture injuries deeper than a half-inch, such as stepping on a nail

*Crushed tissue that bleeds, burns that blister, frostbite, or deep injuries with dirt in them

*Injuries in contact with sea water, especially if you have liver disease

Find out if you have diabetes or other significant medical conditions, such as liver or kidney disease. These conditions may be present without symptoms. Follow your doctor's instructions for improving these conditions.

Talk to your doctor if you have swelling in your limbs that does not go away.

Outlook

Most people respond to the antibiotics in 2-3 days and begin to show improvement. In rare cases, the cellulitis may progress to a serious illness by spreading through the bloodstream. Some forms of severe cellulitis may require surgery and leave a person with scarring.