Skin infection—cellulitis

What is cellulitis?

Cellulitis is an infection of the skin and underlying tissue.

Why do people get it?

The skin is your body’s natural barrier against infection. Everyone’s skin has some bacteria on it and when this barrier is broken you may develop an infection. However, in some cases there is no obvious skin injury found.

Anyone can get cellulitis but people at higher risk of cellulitis are:

  • People with abrasions, grazes or cuts
  • People with athlete’s foot
  • People with eczema
  • People with diabetes
  • People who are immunosuppressed (eg undergoing chemotherapy treatment)
  • People with swollen limbs and those who are overweight
  • Intravenous drug users
  • People who have suffered an insect bite

What are the symptoms?

When the skin is infected it becomes inflamed so:

  • It looks red and swollen, and is hot and tender to touch.
  • It can be variable in size and may spread (“tracking” cellulitis or lymphangitis) causing enlarged glands in the body (eg if cellulitis is on the leg you may feel enlarged glands in your groin)
  • If it is on a limb it may be painful to move it
  • You may develop a fever and flu-like symptoms

Is it serious?

Most cases of cellulitis are mild and many will self-resolve with your body’s own immune system. Problem that can arise:

  • Abscess formation (a localised painful swelling)
  • Rarely it can spread into deeper tissues (eg bones) or into the bloodstream causing a more serious illness

What is the treatment?

Antibiotics

  • A course of antibiotics will usually clear up the cellulitis
  • Normally there is quick improvement, though in the first 24 hours it may look worse before it starts to fade
  • Some bacteria are resistant to common antibiotics so you may need them changed if no response
  • If your infection is severe or the antibiotic tablets do not work quickly enough you may need antibiotic injections into your vein

Elevation

  • Raising the affected part will help reduce associated swelling and alleviate pain

Painkillers

  • Paracetamol and/or ibuprofen will help with pain and fever

Fluids

  • You must keep well hydrated (drink 2–3 litres of fluid per day)

Skin care

  • Prevent further damage to skin and keep skin moisturised

Tetanus immunisation

  • You may need to be given an injection against tetanus

What should I do after I am discharged?

If you have been discharged with a diagnosis of cellulitis:

  • Complete the given course of antibiotics
  • Raise the affected body part where possible
  • Take adequate pain relief
  • Keep well hydrated
  • Keep skin moisturised
  • Take antihistamines to reduce itching

When should I seek urgent medical advice?

Seek urgent medical advice if:

  • No improvement by 48 hours despite antibiotics
  • Rapidly spreading signs or symptoms.
  • Signs of deeper infection (localised prominent swelling, swollen joints etc)
  • Increasing pain
  • Affected skin becomes dusky, purple or blistered
  • You become generally unwell with fever, headache, sickness, or aching all over
Contributors
richardjn George Vasilopoulos