Cellulitis

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What is cellulitis?

Cellulitis is a bacterial infection that typically affects the skin and the tissues beneath the skin. Cellulitis can occur anywhere on the body. Periorbital cellulitis (infection of the eyelids or other soft tissue around the eyes) is a particularly serious form of cellulitis.

Cellulitis is most frequently caused by the bacteria Staphylococcus aureus (including methicillin-resistant S. aureus, or MRSA), Streptococcus pneumoniae, and beta-hemolytic streptococci (including the strep bacteria that cause strep throat). Whenever the offending bacteria enter through a break in the skin—for example, from an injury or insect bite, or through a disorder that breaks the skin, such as cracks or peeling from dry skin, a stye, or a hordeolum (localized bacterial infection of an oil gland or eyelash follicle in the eyelid margin)—they can quickly lead to inflammation and infection.

Cellulitis can be serious and sometimes requires hospitalization; however, in many people, cellulitis responds promptly to antibiotic therapy. The infection can be harder to eliminate in people who have chronic medical conditions, especially conditions that suppress the immune system.

Orbital cellulitis (invasive infection of the soft tissues around the eye) is particularly dangerous for everyone, but especially for children. It often spreads from the sinuses, where S. pneumoniae is the most common cause, but S. aureus and S. pyogenes (the bacterium that causes strep throat) can also cause it. The infection can advance rapidly and in some cases, may cause blindness or other life-threatening complications.

Seek immediate medical care (call 911) if you, or someone you are with, have signs of cellulitis on your face, particularly near your eyes, including painful red, warm or inflamed skin; a rash or sore that appears suddenly and grows rapidly within 24 hours; tight, or a glossy appearance to the inflamed area.

Also seek immediate medical care (call 911) if you, or someone you are with, have serious symptoms of sepsis (a life-threatening reaction to infection, oftentimes one that has spread to the blood), such as severe difficulty breathing and sweating, which may be combined with high fever (higher than 101°F), pale or blue lips, and rapid heart rate (tachycardia). There may also be a change in mental status, such as confusion.

Seek prompt medical care if you are being treated for cellulitis but your symptoms recur or persist.

What are the different types of cellulitis?

Cellulitis is the spread of a skin infection into deeper layers of skin. The three types of cellulitis are:

  • Erysipelas (superficial cellulitis) is an infection in the top layer of skin with well-defined borders. 
  • Purulent cellulitis is a spreading skin infection with drainage (pus draining from the wound) or an abscess has formed. Staphylococcus aureus and methicillin-resistant S. aureus, or MRSA bacteria are the most common causes of purulent cellulitis. 
  • Nonpurulent cellulitis is a bacterial infection spreading into deeper layers of skin than erysipelas, with advancing borders. There is no drainage, pus or abscess formation. Beta-hemolytic streptococci primarily cause nonpurulent cellulitis.

What are the symptoms of cellulitis?

Symptoms of cellulitis can occur anywhere on your skin but are far more dangerous when they occur on your face, especially near your eyes. These symptoms can also be accompanied by flu-like symptoms (fatigue, fever, or aches and pains), including a high fever (higher than 101°F). Symptoms of cellulitis around the eyes always constitute an emergency.

Skin symptoms of cellulitis

Cellulitis symptoms erupt suddenly and grow rapidly. These symptoms are frequently severe:

  • Painful rash or sore that erupts suddenly and grows quickly in the first 24 hours

  • Redness, warmth or swelling

  • Sweating

  • Tight, glossy skin that appears stretched

Eye symptoms of cellulitis

Orbital or periorbital cellulitis symptoms that arise and worsen quickly, are dangerous, and include:

  • Eye pain, especially with eye movement

  • Eye congestion, discharge and redness

  • Loss of vision or changes in vision

  • Painful swelling around the eyes, eyelids, and sometimes the eyebrows and cheeks

Other symptoms of cellulitis

Cellulitis may be accompanied by a variety of symptoms that affect other body systems. Many of these symptoms resemble those of the flu. At times, any of these symptoms can be severe:

Serious symptoms that might indicate a life-threatening condition

In some cases, cellulitis can be life-threatening. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

  • Change in level of consciousness or alertness, such as passing out or unresponsiveness

  • Chills, shaking

  • Eye pain

  • High fever (higher than 101°F)

  • Lightheadedness

  • Painful red, warm or inflamed skin

  • Rapid heart rate (tachycardia)

  • Rash or sore that appears suddenly and grows rapidly within 24 hours

  • Severe difficulty breathing

What does cellulitis look like?

leg with erysipela, a form of cellulitis
Getty

Erysipelas
This superficial form of cellulitis is a potentially serious bacterial infection affecting the upper dermis.

Staph infection on face
Getty

Purulent cellulitis
Purulent cellulitis is a spreading skin infection with pus draining from the wound or a drainable abscess.

A leg with the symptom of bacterial cellulitis
Getty

Nonpurulent cellulitis
Early signs of bacterial cellulitis spreading into deeper layers of skin in the right leg, with swelling and redness. There is no pus or abscess formation.

What causes cellulitis?

Cellulitis is most frequently caused by the bacteria Staphylococcus aureus, Streptococcus pneumoniae, and beta-hemolytic streptococci. Methicillin-resistant S. aureus, known as MRSA, is a particularly dangerous type of bacterial infection that is resistant to many antibiotics. These bacteria can enter through a break in the skin due to an injury, an insect bite, or an area of cracked or peeling skin, and quickly lead to inflammation and infection.

Is cellulitis contagious?

Cellulitis is not contagious. In most cases, it is the bacteria that normally live on your skin that get into a cut or wound and cause the infection.

What are the risk factors for cellulitis?

A number of factors increase the risk of developing cellulitis. Not all people with risk factors will get cellulitis. Risk factors for cellulitis include:

  • Break in the skin or gums, even a small one, such as an insect bite or abrasion

  • Cracked or peeling skin

  • Diabetes (chronic disease that affects your body’s ability to use sugar for energy)

  • Chickenpox or shingles

  • Hot tub use

  • Ischemia (insufficient flow of blood to any tissue)

  • Lymphedema (swelling of the limbs, which can cause skin to crack)

  • Obesity

  • Older age

  • Peripheral artery disease (PAD, also called peripheral vascular disease, or PVD, which is a narrowing or blockage of the arteries due to a buildup of fat and cholesterol on the artery walls, a condition which limits blood flow to the extremities)

  • Recent surgical wound

  • Recent saphenous venectomy (excision of a large vein in the leg near the surface of the skin) for coronary artery bypass surgery

  • Sinus, skin, or dental infection

  • Skin diseases, such as athlete’s foot

  • Weakened immune system

How do you prevent cellulitis?

You may be able to prevent or lower your risk or frequency of cellulitis by taking these steps:

  • Care for all infections promptly.

  • Clean nails daily and keep them short. 

  • Do not swim in natural water, pools or hot tubs if you have a cut or scrape.

  • Ensure children receive the Hib vaccine as recommended. The Hib vaccine protects against Haemophilus influenzae type b infection, a common cause of periorbital and orbital cellulitis.

  • For lymphedema, elevate the affected limb to improve drainage, which will help prevent skin stretching and cracking.

  • Get early treatment for ulcers on your skin or in your mouth.

  • Keep all breaks in the skin or gums cleaned and treated promptly with antibiotics if indicated.

  • Practice good wound hygiene and care after surgery.

  • Treat underlying diseases, such as diabetes and peripheral vascular disease.

Some people develop cellulitis more than once, even several times a year. For recurrent cellulitis, healthcare providers may recommend:

  • Antibiotic treatment for several months

  • Daily washing with an antimicrobial solution, such as chlorhexidine, to prevent staph infections

  • Intranasal washing with mupirocin to prevent staph infections  

What are some conditions related to cellulitis?

Cellulitis is related to other soft tissue bacterial infections including:

  • Abscess, a collection of pus with swelling, pain, and systemic signs of infection, such as fever, chills, fatigue and nausea

  • Furuncles and carbuncles. A furuncle is a well-marked collection of pus from a hair follicle infection. It is painful, swollen and firm. A carbuncle is a group of connected furuncles that drain through multiple pores in the skin.

  • Folliculitis, an infection of hair follicles that may cause pus-filled bumps

  • Gangrene, or gas gangrene, a Clostridium infection leading to tissue death (necrosis) and systemic signs and symptoms of infection

  • Impetigo, an infection involving the top layer of skin and characterized by sores that are mildly painful, red and crusty

  • Necrotizing fasciitis, or flesh-eating disease, an infection of the fascia—the fatty tissues under the skin that protect muscles, blood vessels, and nerves. The bacteria destroy the tissue and are very toxic to the body. Necrotizing fasciitis is a life-threatening illness that can develop suddenly and progress over hours. 

How do doctors diagnose cellulitis?

Healthcare providers diagnose cellulitis by appearance and symptoms. In some cases, they take a sample of tissue or fluid from the infection to identify the bacteria causing it. This is a wound culture. Culture results take time, so most people are treated with broad spectrum antibiotics that kill several types of bacteria at the same time. If the infection does not respond to treatment, the culture results may help explain why.

If cellulitis is severe or there are concerning symptoms, the provider may order these tests:

  • Blood culture, but typically only for people whose immune system is suppressed or compromised

  • Complete blood count

  • C-reactive protein level

  • Imaging tests in case of periorbital or orbital cellulitis

  • Liver and kidney function tests

How is cellulitis treated?

The most common treatment for cellulitis is taking antibiotics by mouth (orally). You may also receive analgesics to control your pain. Cellulitis can be serious enough to require a hospital stay, especially if you have a high fever, unstable blood pressure, persistent nausea or vomiting, or a weakened immune system. You will also be more likely to need hospitalization if your cellulitis occurs around your eyes or if, despite being treated with antibiotics, your infection gets worse.

Most people see improvement in symptoms within 24 to 48 hours of starting antibiotic treatment.

Antibiotics for cellulitis

The most common oral antibiotics for cellulitis include:

  • Amoxicillin plus clavulanic acid (Augmentin)

  • Cephalexin (Cefalex, Cefalin, Keflex)

  • Clindamycin (Cleocin)

  • Dicloxacillin (Dycill, Dynapen), a penicillin class antibiotic

  • Linezolid (Zyvox)

  • Vancomycin (Vancocin, Lyphocin)

Intravenous antibiotics for periorbital cellulitis

Orbital or periorbital cellulitis is usually treated in the hospital with intravenous (IV) antibiotics; surgery may be needed to drain the abscess or relieve pressure. Intravenous antibiotics used for periorbital cellulitis include:

  • Amoxicillin (Amoxil)

  • Ciprofloxacin (Cipro)

  • Dirithromycin (Dynabac)

Pain control

The most common analgesic medications for cellulitis, depending on pain severity, include:

  • Over-the-counter analgesics, such as aspirin (Bayer, Bufferin, Ecotrin), ibuprofen (Advil, Motrin), naproxen (Naprosyn, Anaprox)

  • Narcotic analgesics (for severe pain only), such as acetaminophen with codeine (Elixir, Aceta), codeine (Codeine), hydrocodone (Cortef), morphine (Astramorph PF, Avinza), and oxycodone (ETH-Oxydose, OxyContin, Percolone)

Surgical procedures

Surgical procedures include:

  • Incision and drainage: For purulent cellulitis, surgical incision and drainage of the infection pocket or abscess is necessary. The site may be packed with sterile gauze to improve wound drainage. Antibiotics may or may not be prescribed.

  • Debridement: For nonpurulent cellulitis and necrosis (dead tissue), a surgeon will surgically remove the dead, infected tissue, a margin of healthy tissue, and clean the area to prevent further spread of infection. 

Home remedies for cellulitis

Cellulitis will not go away with home remedies alone. But, there are some simple and natural things that may help with healing and the effects of antibiotic treatment. These include:

  • Apply a clean, damp cloth to the affected area several times a day. Your care team may give you sterile bandages to apply. 

  • Elevate the affected area. 

  • Eat a nutritious, healthy diet full of brightly colored vegetables and fruit, whole grains, and lean meats.

  • Balance your body’s balance of “good” and “bad” bacteria with probiotics—products containing immune-boosting bacteria.  

  • Supplement your diet with daily vitamin and mineral supplements that boost immune system function, such as vitamin C and zinc.

Alternative treatments for cellulitis

Alternative treatments for cellulitis should only be complementary to medical treatment with antibiotics. Never use alternative treatment alone, without taking antibiotics prescribed by a licensed healthcare provider. Alternative treatments may help boost immunity and certain underlying risk factors for cellulitis, such as lymphedema, but not cellulitis itself.

Alternative practices may include:

  • Acupuncture

  • Homeopathy

  • Herbal supplements, taken by mouth, that strengthen the immune system, such as echinacea

  • Herbal supplements for the skin, such as yarrow, tea tree oil, and calendula. Check with your doctor before applying anything on the affected area. 

What are the potential complications of cellulitis?

Complications of untreated or poorly controlled cellulitis can be serious, even life-threatening in some cases. You can help minimize your risk of serious complications by following the treatment plan you and your healthcare professional design specifically for you. Complications of cellulitis can include:

  • Blindness

  • Recurrent infection

  • Cosmetic deformity

  • Lymphangitis (lymph vessel inflammation)

  • Meningitis (infection or inflammation of the sac around the brain and spinal cord), a complication of facial cellulitis

  • Necrosis (death) of tissues and gangrene, which may require removal of the dead tissues or amputation

  • Osteomyelitis (bone infection)

  • Sepsis (life-threatening reaction to infection)

  • Shock
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Jan 16
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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