Cellulitis

Edited by Dr Claudia Pastides, 12th February 2020

What is Cellulitis?

Cellulitis is an infection which affects the deeper layers of your skin and the tissues which surround it. The affected area will look red and inflamed, and may feel hot to the touch. The condition most commonly affects the legs, but it can happen anywhere on the body, and affect anyone.

Cellulitis is very different from cellulite, which is the dimpled skin people find on their thighs, bottoms and tummies. Cellulite is not in any way related to cellulitis.

Cellulitis can be serious if not treated quickly with appropriate medication, often antibiotics. The infection can spread deeper into the skin or to other areas of the body, causing sepsis or necrotizing fasciitis, which are life-threatening if not treated.

Read on to discover the early signs and symptoms of cellulitis - and speak with a doctor today if you believe you may be suffering from this condition.

Causes of cellulitis

Cellulitis is usually the result of a bacterial infection, which has entered the body through a cut, a graze or a bite. The bacteria spreads to the deeper layers of the skin, causing worsening symptoms. In rare cases, cellulitis can also be caused by fungal infections.

People more at risk of developing cellulitis:

Have had cellulitis before
Have poor circulation in their limbs
Have a weakened immune system for any reason
Have diabetes
Use intravenous drugs
Have lymphoedema, a condition where fluid builds up under the skin
Have a wound

Symptoms of cellulitis

Cellulitis causes skin to become swollen and red. It may be painful, and warm to the touch. As cellulitis is an infection, it is accompanied by some of the typical side effects of an infection, including a high temperature, feeling unwell or swollen glands.

In some rare cases, cellulitis can develop into far more serious illnesses, including sepsis, or spread to other parts of the body. If you start to experience dizzy spells, feel cold or clammy, vomiting, heart palpitations, or if the affected area of skin expands rapidly, seek medical attention immediately.

Conditions that may present in a similar way to cellulitis

Erysipelas is very similar to cellulitis. It is also an infection of the skin. The difference is that erysipelas involves only the upper layers of skin, as opposed to cellulitis which affects the deeper tissues. The two can overlap and it isn’t always possible to tell if you have one or the other. Treatment is usually the same for both infections.

Dermatitis (also known as eczema) is a common condition where the skin is inflamed, often over a long period of time, going through phases where it worsens and improves. It typically causes itchy, dry and red skin, that can sometimes blister and crust. Dermatitis makes the skin more susceptible to cellulitis and so if you have eczema it can become infected, leading to cellulitis.

Abscesses are painful collections of pus that usually present as a bump on the skin. Skin abscesses are usually caused by bacterial infections and cause pain, redness and fever around the area where the abscess has formed under the skin.

Deep vein thrombosis (DVT) is caused by a blood clot, often in the leg, making the leg swollen, red, hot and painful. DVTs can present in a similar way to cellulitis, so it is important to speak to a doctor if you have symptoms of cellulitis so that they can rule out a DVT.

Treatment for cellulitis

As with many bacterial infections, cellulitis is treated with a course of antibiotics.

For milder cases, oral antibiotics (antibiotic tablets that are swallowed) are prescribed to clear the infection. Most people feel better after about 2 days of antibiotics and most make a full recovery within a week or two. In more serious cases, people are referred to hospital for treatment, to be more closely monitored and given antibiotics straight into a vein using a drip.

The antibiotics you’ll be prescribed depend on the severity of the infection, the part of the body affected and the reason why you developed cellulitis, as well as any history of allergies to antibiotics.

Mild cellulitis

Flucloxacillin 500-1000mg four times a day for 5-7 days is often prescribed for milder cases of cellulitis (and people that are not allergic to penicillins).

For people allergic to penicillin, clarithromycin 500mg twice a day for 5-7 days tends to be the antibiotic of choice. Doxycycline is another option and erythromycin is often recommended for use in pregnancy.

Cellulitis near the eyes or nose

Some infections around the eyes or nose require referral to hospital for specialist treatment, however in milder cases you may be prescribed antibiotics by your GP.

Augmentin (a combination of amoxicillin and clavulanate potassium) is often the antibiotic of choice, except for in the case of penicillin allergy, when a combination of clarithromycin and metronidazole would often be prescribed.

Whilst recovering, over the counter pain relief can help with discomfort, such as paracetamol. Not all over the counter medications are suitable for everyone or for use if you’ve got cellulitis, so if you haven’t used a certain painkiller before or aren’t sure if it is safe to do so- discuss it with a pharmacist first.

Drinking plenty of fluids, regularly moving the affected joint or limb, and keeping the affected area elevated to reduce swelling can all be helpful.

Cellulitis that’s not improving despite antibiotics

If after about 2 or 3 days of antibiotics, the infection hasn’t started to improve or if it seems to be worsening, speak to your doctor.

After 7 days of antibiotics, if your cellulitis hasn’t improved significantly and you haven’t got a fever, the cellulitis is mild and you feel well in yourself - your doctor might prescribe a further 7 days of antibiotics.

If at any point during your treatment you feel unwell, have a fever or the cellulitis seems to be worsening - speak to your doctor.

Recurring cellulitis

Cellulitis can recur, sometimes in the same place. If cellulitis recurs in the same place twice in one year your GP will consider referring you to a specialist. The specialist might recommend a daily low dose of antibiotic, to try and prevent the infection from returning.

It may not always be possible to prevent recurrent cellulitis but other things that help include:

Managing skin conditions, such as eczema
Treating open wounds and ulcers effectively
Treating any cracked skin between the toes and using antifungal cream if there is a fungal foot infection present

Frequently asked questions about cellulitis

1. Is cellulitis contagious?

Cellulitis is not contagious. You can’t pass it on to another person by being in the same room or in close proximity to them. Cellulitis is a bacterial infection, so it is important for healthcare professionals applying dressings and caring for cellulitis to wear gloves and wash their hands well before and after. But unless you’re in direct contact with a skin infection and have an open wound or broken skin yourself, it is very unlikely you can get an infection from someone else’s cellulitis.

2. What does cellulitis look like?

Cellulitis usually looks very red, feels hot and the skin can look quite swollen. Other conditions can sometimes look similar, such as erysipelas, dermatitis and DVT.

3. Does cellulitis itch?

Cellulitis is not usually itchy however it can be itchy for some people, especially if you have any cracks in your skin and they’ve started healing. Very itchy and dry rashes are more likely to be due to dermatitis than cellulitis.

4. Can I go to work with cellulitis?

Yes, you can go to work with cellulitis if you feel well enough to and can carry your job out safely and as normal.

5. Can you fly with cellulitis?

Yes, if you’re on antibiotics, things are improving and you know you’ll be able to access healthcare if needed at your destination, you can fly with cellulitis. But it is best to speak to your doctor about this for advice that is more specific to you.

6. Can I swim with cellulitis?

It is best not to swim if you currently have cellulitis. Wait until it is all better and healed. Chlorinated pools can cause irritation and dryness of the skin for some, potentially worsening cellulitis.

7. What is the best treatment for cellulitis?

The best treatment for cellulitis caused by bacteria is antibiotics. There are a few different antibiotics that are used, depending on the location of cellulitis or if the person affected has other medical problems.For bacterial cellulitis that can be treated safely in the community and without admission to hospital, flucloxacillin for 5-7 days is usually prescribed. If allergic to penicillin, clarithromycin or doxycycline are recommended. If pregnant, erythromycin is usually advised.Cellulitis that occurs on the face (near the eyes or nose) is often treated with co-amoxiclav (Augmentin) for 7 days, or clarithromycin (if allergic to penicillin).

People with lymphoedema are often prescribed amoxicillin, sometimes together with flucloxacillin, for 14 days or more.Antibiotic choice varies depending on the country or area you live and what bacteria is likely to be causing the infection.

8. How long does it take for cellulitis to clear up?

Most people start to feel better and notice an improvement in their cellulitis within 3 or 4 days, although it is important to finish the full prescribed course of antibiotics. By a week or two, the skin is typically back to normal.

9. Can cellulitis go away on its own?

It isn’t recommended to leave cellulitis untreated as it can lead to life-threatening complications, such as sepsis and necrotizing fasciitis. Treatment speeds up the recovery and reduces the risk of complications, so it is important to speak to a doctor if you think you might have cellulitis.

10. How dangerous is cellulitis infection?

Cellulitis isn’t always dangerous but it has the potential to be, especially if the person also has other health problems, is very young (under 1 year old) or frail. Fortunately, with prompt treatment, cellulitis can be cured quickly in most people and without any complications.

If you think you might be suffering from cellulitis, contact a GP to discuss it.

The information provided is for educational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Seek the advice of a doctor with any questions you may have regarding a medical condition. Never delay seeking or disregard professional medical advice because of something you have read here.