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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 Staphylococcus aureus, or MRSA), Streptococcus pneumoniae, and beta-hemolytic streptococci. 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. 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 bacterial blood infection), such as severe difficulty breathing and sweating, which may be combined with high fever (higher than 101 degrees Fahrenheit), pale or blue lips, and rapid heart rate (tachycardia).

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


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 degrees Fahrenheit). 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 arise and worsen quickly, are dangerous, and include:

  • Orbital cellulitis symptoms arise and worsen quickly, are dangerous, and include:
  • Eye pain, especially with eye movement
  • Eye swelling 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 degrees Fahrenheit)
    • 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 causes cellulitis?

    Cellulitis is most frequently caused by the bacteria Staphylococcus aureus, Streptococcus pneumoniae, and beta-hemolytic streptococci. Methicillin-resistant Staphylococcus 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.

    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

    • Cracked or peeling skin

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

    • Chickenpox or shingles

    • History of 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)

    • Ischemia (insufficient flow of blood to any tissue)

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

    • Older age

    • Recent surgical wound

    • Sinus, skin, or dental infection

    • Weakened immune system

    Reducing your risk of cellulitis

    While not all risk factors can be avoided, you may be able to lower your risk of cellulitis by:

    • Caring for all infections promptly

    • Ensuring that children receive Hib vaccine as recommended

    • Getting early treatment for ulcers on your skin or in your mouth

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

    • Practicing good wound hygiene and care after surgery


    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.

    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)

    • 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)

    Analgesic medications for 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)

    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 health care professional design specifically for you. Complications of cellulitis can include:

    • 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 bacterial blood infection)

    • Shock

    Was this helpful?
    Medical Reviewer: William C. Lloyd III, MD, FACS
    Last Review Date: 2019 Jan 4
    1. Cellulitis. PubMed Health, a service of the NLM from the NIH. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001858/
    2. Orbital cellulitis. MedlinePlus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/001012.htm
    3. Domino FJ (Ed.) Five Minute Clinical Consult. Philadelphia: Lippincott Williams & Wilkins, 2013.
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