- Skin Care and cellulitis management
- Hints and tips
- What are cellulitis and erysipelas?
- What causes cellulitis?
- Who gets cellulitis?
- What are the symptoms of cellulitis?
- What does cellulitis look like?
- Where does cellulitis occur?
- Is there anything else cellulitis could be?
- Why is cellulitis so painful?
- Is cellulitis serious?
- What is the treatment for cellulitis?
- When do I need to worry with cellulitis?
- How can I prevent cellulitis?
- How long does it take cellulitis to clear up?
- Is cellulitis contagious?
- How long do I need off work for cellulitis?
- Treatment Options for Cellulitis
- Intravenous Antibiotics, Surgery, and More
- Portals of bacterial entry
- Who is at risk?
- Causative organisms
- Differential diagnoses
- Diagnostic studies
- Diagnosing and managing lower limb cellulitis
- Cellulitis: Diagnosis and treatment
Skin Care and cellulitis management
Just below the surface of our skin is a vast network of superficial lymphatic vessels. The vessels help to clear away any substances on the skin such as infections, allergies, biological hazards.
People with Lymphoedema are less able to clear these substances away, which increases the risk of developing infections (cellulitis). This can lead to further swelling of the affected limb(s) and repeated infections.
Therefore, meticulous skin care is vital in patients with Lymphoedema and those at risk of developing Lymphoedema.
As we age the natural moisturising factors start to diminish, and skin becomes much drier. This causes the skin to thicken and cracks can develop that can encourage bacteria (infection) to enter.
It is important to maintain healthy skin in people who suffer with Lymphoedema. This can be achieved by following these simple steps listed below:
- Observe your skin daily; check for scratches, redness, abrasions or cuts. Treat immediately with antiseptic cream such as Savlon.
- Monitor for signs of infection (cellulitis); check for skin changes, redness, increased swelling, flu-like symptoms, and fever. Seek urgent medical attention for antibiotic therapy.
(For further information on Cellulitis management see the PDF links above).
- Cleaning your skin daily; clean gently, ensuring you pay attention to any skin folds and in-between the fingers and toes. Dry your skin by patting rather than rubbing.
- Use natural products to wash with; such as Aqueous cream, hydromol ointments/shower wash, E45 wash, aveeno.
- Moisturise your skin daily; moisturise every evening to ensure you keep the skin as soft and subtle as possible. Your lymphoedema nurse will prescribe you an emollient suitable for your skin type.
- Recommended moisturises include;
- Aveeno Cream
- Hydromol Cream/Ointment
- Balneum Cream
- Epaderm Cream
- Coconut oil BP
- Vitamin E oil
- Double base
Hints and tips
- Dry your skin well, especially between toes and fingers.
- Use an antiseptic cream immediately for burns, scratches and cuts.
- Use an insect repellent and high factor sun lotion on holidays/travels.
- Use an electric razor for shaving.
- Do not have blood samples, blood pressure or injections taken on the affected limb.
- Avoid hot baths, sauna and sunbeds.
- Apply cream/lotion in the evening (it will soak into your skin overnight).
What are cellulitis and erysipelas?
Cellulitis is an infection of the deep layer of skin (dermis) and the layer of fat and tissues just under the skin (the subcutaneous tissues).
Erysipelas is an infection of the skin which is nearer to the skin surface (more superficial) than cellulitis.
In reality, it is difficult to tell how deep an infection is, so cellulitis and erysipelas are much the same thing.
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What causes cellulitis?
Cellulitis is mainly caused by two bacteria: Staphylococcus aureus and beta-haemolytic streptococcus.
We all have bacteria, including these ones, living harmless on our skin. Cellulitis occurs if the skin is broken and the bacteria can delve down deep into the skin.
Who gets cellulitis?
Cellulitis is quite common but often things that aren’t cellulitis are misdiagnosed as it. In theory it can affect anyone but is very rare in children and healthy young adults.There are some things that can make you more prone to cellulitis. For example, if you:
- Are elderly.
- Have swollen legs (for various reasons) or are overweight or obese.
- Have previously had an episode of cellulitis.
- Have a weak immune system – for example, if you take steroids or chemotherapy.
- Are pregnant.
- Have poorly controlled diabetes.
- Are an intravenous drug user.
- Have severe eczema or other skin conditions that cause cracks in the skin, like athlete’s foot.
What are the symptoms of cellulitis?
- Redness in the skin, usually the lower leg.
- The redness gets worse over a day or two, becoming painful.
- The skin will look a bit shiny.
- The skin is smooth; it is not bumpy or raised.
- Cellulitis is not normally itchy until it starts to go away and the skin heals. Cellulitis is not itchy in the early stages of the infection.
- You may feel unwell, with a raised temperature (fever).
- If the cellulitis becomes very bad you may feel shivery and weak.
What does cellulitis look like?
Here is a photo of severe cellulitis on a child’s eyelid, after they were bitten by a dog:
Image source: Open-i (Gonzalez MO et al) see Further reading reference below
This photo shows the slightly less serious infection, erysipelas, on a lady’s face. Erysipelas is more likely on the face than cellulitis, and often goes across the nose and cheeks:
This photo shows cellulitis in the foot of someone with diabetes. A doctor or nurse has drawn around the infection with a pen, to assess if it has spread further the following day:
Cellulitis diabetic foot
Image source: Open-i (Edmonds M) – see Further reading below
This photo shows cellulitis just under the scar from breast reconstruction surgery as part of treatment for breast cancer.
Cellulitis of the breast
Image source: Open-i (Nguyen MD et al) – see Further reading below
Where does cellulitis occur?
- Cellulitis mainly starts on the lower leg, just around the ankle.
- It can also occur on the face, particularly around the eyelids when it is called periorbital cellulitis.
- Sometimes very bad sinusitis can spread into the eye, causing it to bulge out. This is very serious and is called orbital cellulitis.
- Sometimes it can occur on the back of the elbow, from leaning on the elbow too much (this is similar to olecranon bursitis, also called student’s elbow).
Is there anything else cellulitis could be?
- A lot of conditions look like cellulitis but aren’t: it’s important the diagnosis of cellulitis is correct, otherwise you’d be taking antibiotics for no reason.
- Insect bites often give a red circle of skin around where the bite was: a lot of people (and doctors) think it is cellulitis and give antibiotics. It’s actually very rare for insect bites to become infected. The redness around an insect bite is just a normal histamine reaction: it will go away in a few days and you can take antihistamines to help. The key difference between insect bites and cellulitis is that insect bites are itchy, but cellulitis isn’t (at least, not until it is healing and the skin is flaky). Also, the redness around an insect bite comes on quickly – often overnight. Cellulitis takes a few days to spread.
- A lot of elderly people have varicose eczema: this causes red legs and can make a lot of people think they have cellulitis. The key difference is, varicose eczema usually affects both legs, whereas cellulitis affects only one at a time. Varicose eczema also isn’t painful, whereas cellulitis is. And elderly people have usually had varicose eczema for years; cellulitis comes on over a few days and gets worse and worse.
Why is cellulitis so painful?
The infection in the skin causes swelling. It is this swelling that is painful, because it presses the skin out.
Is cellulitis serious?
In general, cellulitis can be treated effectively at an early stage with antibiotics and does not normally become a serious problem in developed countries. If the person has a particularly weak immune system – for example, from medications that suppress the immune system, or from HIV – then it could become serious.
Possible complications of untreated cellulitis include:
- Blood poisoning (septicaemia) which can be life-threatening.
- A ball of pus (an abscess) forming in the infected area.
- Muscle or bone infections which can be serious.
- Cellulitis around an eye, which can spread to infect the brain.
- Bacteria that get into the bloodstream and which can cause an infection of the heart valves.
So, the ‘take home message’ is: if you have a patch of skin that is red, warm and seems to be getting larger, see a doctor as soon as possible. With treatment, most people with cellulitis make a full recovery without any complications developing.
What is the treatment for cellulitis?
A course of antibiotic tablets will usually clear cellulitis.
The antibiotics that usually work for cellulitis are:
- Cefalexin (which is used more in the USA for cellulitis).
Usually it is sufficient to take a week of antibiotic tablets. The usual course would be a week, followed by a second week if it hadn’t cleared.
Sometimes it will be necessary to be given antibiotics through a vein (intravenous antibiotics). This would be necessary if you had a high temperature (fever) from the cellulitis, or had bad shivering. Your doctor will assess whether they think intravenous antibiotics are necessary.
Raising (elevating) your affected body part uses gravity to help prevent excess swelling, which may also ease pain. Do this as much as possible until the infection clears.
If you have a cellulitis of the leg, ‘raised’ means that your foot is higher than your hip so gravity helps to reduce the swelling. When they are told to elevate a leg, many people put their leg on a chair or footstool. This is rarely sufficient (even if the chair reclines), as the ankle has to be higher than the hip for elevation to be useful. The easiest way to raise your leg is to lie on a sofa with your heel up on the arm of the sofa (but avoid pressure on the calf). Or, lie on a sofa with your foot on two or three thick cushions. When in bed, put your foot on several pillows so that it is higher than your hip. Alternatively, empty a deep drawer and put it under the mattress at the foot of your bed.
You may need to keep your foot elevated as much as possible for a few days. However, to aid circulation, you should go for short walks every now and then and wiggle your toes regularly when your foot is raised.
If you have cellulitis in a forearm or hand, a high sling can help to raise the affected area.
Other things that may help
- Painkillers such as paracetamol or ibuprofen, which can ease pain and reduce a fever.
- Treatment of athlete’s foot if it is present.
- Using a moisturiser cream and soap substitute on the affected area of skin until it heals. This helps to prevent the skin from becoming dry and damaged.
- Drinking plenty of fluids to help prevent lack of fluid in the body (dehydration).
When do I need to worry with cellulitis?
- Cellulitis usually gets better with antibiotics: you should feel an improvement within two days of taking them.
- If the skin redness gets bigger and more painful, that is a sign that the antibiotics aren’t working: see your doctor in case they think you need a higher dose or a different antibiotic.
- If you feel really unwell, with a high temperature (fever) and the shivers: this could be a sign the bacteria have spread into your bloodstream.
- If the skin, which was red, turns dark purple or black: this could be a sign you have dead tissue (which doctors call gangrene). This needs immediate hospital admission.
- If the pain of the cellulitis seems out of proportion to the size of the redness: this could be a sign the infection has spread deeper into your skin and you might be developing necrotising fasciitis, which is a very serious skin infection. This needs immediate hospital admission.
How can I prevent cellulitis?
Cellulitis may not always be preventable, particularly in the elderly or people with a weak immune system. However, the following may help to reduce your risk of developing cellulitis in some cases:
- If you have swollen legs, try to keep them elevated as high as possible whle you’re sitting down. This may well be the most important thing you can do to prevent skin infections in your lower legs.
- Clean any cuts or wounds that you may have. You can wash them under running tap water. You may want to use an antiseptic cream. You can also cover the cut or wound with a plaster. However, make sure that you change the plaster regularly (particularly if it becomes wet or dirty).
- Don’t let your skin become too dry. Dry skin can crack easily and germs (bacteria) can enter through the skin cracks. Use a moisturiser regularly on your skin.
- Avoid scratching your skin if possible. Conditions such as eczema can make skin very itchy. If your fingernails are long, they can cause breaks in the skin when you are scratching. These breaks can be an entry point for germs. So, keep your fingernails short and avoid scratching as much as possible.
- If you have had episodes of cellulitis in the past then you may be given a long-term course of low-dose antibiotics. These have been shown to reduce future episodes of cellulitis.
How long does it take cellulitis to clear up?
- Mild cellulitis that is treated early could be completely clear in a week, particularly if you are otherwise healthy.
- In the elderly, or if the cellulitis has set in for a while before starting treatment, it is quite common to need two weeks of antibiotics.
- If you have had bad cellulitis requiring hospital admission you may find that the cellulitis doesn’t quite go away completely for several months.
Is cellulitis contagious?
Thankfully not! The infection is deep in the skin, not on the surface. You can’t catch cellulitis by touching it, nor do you have to wear gloves if touching the skin of someone with cellulitis.
How long do I need off work for cellulitis?
- If you have cellulitis it is important to rest, stay well hydrated and keep your legs elevated (or whichever part of your body has the cellulitis). If your work involves standing up for long periods of time (like a hairdresser or teacher) or if you are sitting in an office chair most of the day, you may well need to have a week off work.
- Most doctors would advise being off work until the cellulitis is completely better: probably a week at the minimum.
- Your doctor will be best placed to advise you on this.
Treatment Options for Cellulitis
Intravenous Antibiotics, Surgery, and More
If your cellulitis is severe, purulent (discharging pus), or affecting certain parts of the body, you may need treatment beyond oral antibiotics. Treatments for severe cellulitis include the following:
“Typically, if a patient is not responding to oral antibiotics, and the cellulitis has symptoms that appear to be more involved and can’t be managed with antibiotics, such as high fever or low blood pressure — systemic signs of infection — then they get intravenous antibiotics,” says Kaminska. “That usually occurs in a hospital setting.”
Intravenous treatment can include penicillin, ceftriaxone, cefazolin, nafcillin, and clindamycin, among other antibiotics. (9)
In the case of abscess, gangrene (dead tissue), or other symptoms involving purulence, surgery is usually necessary to remove the infected tissue. For an abscess, typically an incision is made and the pus is drained out, says Kaminska. “Antibiotics are not going to treat that pocket of infection. It needs to be released.”
Most times, surgery alone is used to address a purulent infection, without the addition of antibiotics, unless the person is also experiencing a systemic infection or a condition such as necrotizing fasciitis. (5).
Also known as “flesh-eating disease,” necrotizing fasciitis is caused by a quickly spreading bacterial infection of the fascia (connective tissue) and surrounding soft tissue, causing the tissue to die. It can result in the loss of limbs or even death. To treat it, the dead tissue is surgically removed, and intravenous antibiotics are administered. (10).
Orbital cellulitis, which affects the fat and muscle around the eye, is a serious condition that can result in blood poisoning (septicemia) or blindness. It may require surgery to relieve pressure around the eye or any abscesses that may be involved, as well as IV antibiotics. (11)
You may need special wound coverings or dressings to aid in the healing process after surgery for cellulitis. A wound care nurse or other medical professional will show you how to apply and change them, as well as how to keep your wound clean. (4)
Antibiotic ointments are rarely prescribed for the treatment of cellulitis, but in the case of a condition such as perianal streptococcal cellulitis, which affects the anus and rectum, a topical antibiotic, such as mupirocin or retapamulin, may be prescribed. (12,13)
If you have cellulitis in a leg, you may be told to keep it elevated.
“Lifting the leg for drainage is really key,” says Dr. Bystritsky. “It will help reduce the swelling and help your condition to improve.”
Treating Underlying Conditions
Treating any conditions that may have predisposed you to developing cellulitis, such as diabetes, cancer, HIV or AIDS, lymphedema, or peripheral vascular disease, may help to lower your risk of developing cellulitis again.
Overweight and obesity are also associated with a greater risk for cellulitis, and losing some weight lowers that risk. (14)
Mr. W, a 60-year-old with type 2 diabetes mellitus, bumped his right shin on the dresser in his bedroom. Three days later, he experienced increasing pain over the shin and observed redness and mild swelling. After examining the area and taking a history, the man’s primary-care clinician diagnosed cellulitis.
Cellulitis is an acute infection and inflammatory response in the dermis and subcutaneous tissue, commonly seen by providers in primary care, emergency medicine, and surgery. In the United States, the annual incidence is approximately two to three cases per 100 people.1,2 A break in the skin allows entry of bacteria. Most cases of cellulitis are uncomplicated and treated in the outpatient setting with oral antibiotics. However, the rapid rise of resistance in gram-positive bacteria, particularly methicillin-resistant Staphylococcus aureus (MRSA), has made the selection of empiric therapy more difficult. Prompt and effective therapy is crucial because cellulitis has the potential to progress to serious illness in other parts of the body by contiguous spread or via the lymphatic or circulatory system.
Portals of bacterial entry
Cellulitis occurs where the skin has been broken. Trauma (including contusions, abrasions, lacerations, and puncture wounds), insect bites, animal and human bites, surgical wounds, burns, sites of IV catheter insertion or IV injection of illicit drugs (skin-popping), and even small, imperceptible cracks in the skin predispose patients to cellulitis.
The infection is also associated with other skin conditions, including abscesses, furuncles, carbuncles, impetigo, varicella, and tinea pedis. When assessing patients with lower-extremity cellulitis, clinicians must be sure to examine the feet for interdigital dermatophytic infections and treat as necessary with topical antifungal agents.
Who is at risk?
Mr. W’s diabetes and his age put him at increased risk for cellulitis. Persons with diabetes mellitus are 1.8 times more likely to develop cellulitis than those without diabetes.3 Sensory neuropathy, atherosclerotic disease, and immune alterations all predispose the diabetic patient to skin and soft-tissue infections. Elderly persons and patients with other forms of immunocompromise are also at increased susceptibility. Additional risk factors include chronic steroid use, impaired peripheral circulation (peripheral arterial disease and venous stasis), chronic edema, obesity, and lymphadenectomy following tumor excision, e.g., after a mastectomy.
Presenting signs and symptoms Like Mr. W, patients with cellulitis usually complain of localized pain and swelling and may have a history of trauma, bite, dermatitis, or surgery. The lower extremities are the most common site for cellulitis, but any part of the body can be involved. On examination, the affected skin is erythematous and warm, with edema and tenderness. The borders are usually irregular but defined; marking the borders with an indelible pen allows objective assessment of progression or resolution. Regional lymphadenopathy may be present. Make note of any breaks in the skin, lymphangitic streaking, peripheral edema, diminished peripheral pulses, or heart murmur. Fever and chills are signs of systemic involvement.
Streptococcus pyogenes (also known as group A b-hemolytic streptococcus ) and S. aureus are the most common causative agents of community-acquired cellulitis in immunocompetent persons. Cellulitis associated with abscesses, furuncles, or carbuncles is usually caused by S. aureus. In contrast, cellulitis that is diffuse, i.e., not associated with a defined portal of entry or purulence, is commonly caused by GABHS or a streptococcus plus S. aureus.4
Some situations require consideration of other causes: In immunocompromised persons, cellulitis may be due to gram-negative bacteria, and pneumococci may cause a particularly malignant form of cellulitis that develops through the bacteremic route. Cellulitis in the setting of a deep diabetic foot ulcer may have a wider spectrum of potential pathogens. Important historic clues to other causes of cellulitis include animal and human bites, water contact, trauma, and surgery (Table 1).
Necrotizing fasciitis, an infection of the fascia of deep muscle, should be considered in the differential diagnosis of cellulitis. Overlying cellulitis often accompanies necrotizing fasciitis. An early clue to this diagnosis is pain disproportionate to the skin findings. Late findings include purple bullae, skin sloughing, crepitus, and systemic toxicity. Without surgical debridement, necrotizing fasciitis is fatal.
Noninfectious diseases can also mimic cellulitis and should be considered, particularly if the patient does not respond to appropriate antimicrobial therapy. Common noninfectious masqueraders include superficial and deep venous thrombosis, contact dermatitis, insect stings, tick bites, gout, fixed drug eruptions, and erythema nodosum.5
Diagnosis is based on appearance of the skin and patient history. In these days of increasing antibiotic resistance, drainage from an abscess or weeping wound associated with cellulitis should be sent for culture and sensitivities. Material from needle aspiration of inflamed skin or skin biopsy can be cultured in cases of cellulitis without purulence, abscess, or a necrotic lesion, but this is usually not required. Instead, these procedures may be reserved for patients with unusual predisposing factors.
Because <5% of blood cultures are positive, they are not indicated in typical cases of cellulitis. Indications for blood cultures include significant fever and chills, severe immunocompromise, periorbital cellulitis, and cellulitis superimposed on lymphedema.6 A polymorphonuclear leukocytosis is often present with cellulitis; a complete blood cell count and differential may help gauge the severity of infection and the hematologic response.
In most cases of cellulitis, radiologic studies are unnecessary. Plain x-rays or CT is used when subjacent osteomyelitis is suspected, as in patients with a diabetic foot ulcer and cellulitis. When differentiating cellulitis from necrotizing fasciitis proves difficult, CT or MRI may show edema or fluid collection along the fascial plane. In cases in which you suspect necrotizing fasciitis, however, do not delay surgical exploration for a definitive diagnosis.4
From the November 06, 2007 Issue of Clinical Advisor
Diagnosing and managing lower limb cellulitis
The benefits of the service are:
- A faster pathway;
- Less pressure on resources;
- Reduced waiting lists helping to achieve the four-hour wait target in accident and emergency;
- Early discharge/preventing admission;
- Patients are not exposed to hospital-acquired infections;
- Care in the community, with patients remaining closer to home;
- Prevention of recurrent episodes of cellulitis.
Studies have supported this change of clinical pathway and management of lower limb cellulitis. Seaton et al (2005) recognised high standards in nurse-led home IV services using ceftriaxone. They concluded that care is not compromised and the need for medical review is reduced. Corwin et al (2005) said home IV treatment is as effective as hospital inpatient treatment and is more acceptable to patients.
Depending on the location of the affected area, patients may need to decrease physical activity and elevate the extremity, if possible. They may take over-the-counter pain medication such as ibuprofen or paracetamol if there are no contraindications. Where patients are started on oral antibiotics, review should take place after 5-7 days with the proviso that they contact the surgery or outpatient department if they have any of the following features:
- Raised temperature, especially when associated with rigors;
- Cellulitis with soft, fluctuant areas suggestive of abscess formation;
- A red streak from an area of cellulitis or a progressively fast-spreading area of redness;
- Significant pain not relieved by recommended analgesia;
- Inability to move an extremity or joint because of pain;
- Nausea and vomiting.
Patients with diabetes, cancer or immunosuppression should be made aware that localised cellulitis may become serious.
Health professionals need to consider cellulitis as a multidisciplinary issue that requires more than just treating the infection. Assessment has to be all-inclusive to manage patient care effectively and, in many, the aim is to avoid recurrent episodes. Good background knowledge of common presenting skin disease is essential and practitioners should have adequate knowledge to diagnose, treat or refer. Awareness of risk factors is also important not only in the initial assessment but also to educate patients about ongoing management and prevention.
- It is important to recognise diagnostic features of clinical presentation to ensure accurate diagnosis and correct management of cellulitis
- Assessment of the lower limb needs thorough skin examination to exclude or diagnose active skin disease
- Misdiagnosis is common; practitioners should be aware of potential differential diagnosis and appropriate investigations
- Ongoing patient advice and education is key as patients may experience further episodes; risk factors need to be highlighted
- Cellulitis management should be considered using a multidisciplinary approach
Anderson I (2006) Aetiology, assessment and management of leg ulcers. Wound Essentials; 1: 20-37.
Barron GS et al (2007) Dermatologic complications of venous disease: medical management and beyond. Annals of Vascular Surgery; 21: 5, 652-662.
Beldon P (2009) Managing “wet legs” in patients with chronic oedema. Wounds UK; 5: 2, 20-23.
Björnsdóttir S et al (2005) Risk factors for acute cellulitis of the lower limb: a prospective case-control study. Clinical Infectious Diseases; 41: 10, 1416-1422.
Clinical Resource Efficiency Support Team (2005)CREST Guidelines on the Management of Cellulitis in Adults. Belfast: CREST.
Corwin P et al (2005) Randomised controlled trial of intravenous antibiotic treatment for cellulitis at home compared with hospital. British Medical Journal; 330: 129.
Cox NH (2002) Management of lower leg cellulitis. Clinical Medicine; 2: 23-27.
Davis R (2001) Treatment issues relating to dermatology. In: Hughes E, Van Onselen J (eds) Dermatology Nursing. A Practical Guide. Philadelphia, PA: Harcourt Health Sciences.
Duffill M (2008) Lipodermatosclerosis. DermNet NZ.
Gunderson CG (2011) Cellulitis: definition, etiology and clinical features. American Journal of Medicine; 124: 12, 1113-1122.
Kilburn S et al (2003) Intervention for cellulitis and erysipelas (protocol). Cochrane Database of Systematic Reviews. 2003; Issue 1, Art No CD004299.DOI: 101-1002/14651858.
McNamara DR et al (2007) Incidence of lower-extremity cellulitis: a population-based study in Olmsted county, Minnesota. Mayo Clinic Proceedings; 82: 7, 817-821.
Mortimer P (1995) Managing lymphedema. Clinics in Dermatology; 13: 499-505.
Pierce RP, Daugird AJ (1992) Recurrent leg cellulitis: pathogenesis, treatment and prevention. Journal of the American Board of Family Practice; 5: 1, 85-87.
Quartey-Papafio CM (1999) Lesson of the week: importance of distinguishing between cellulitis and varicose eczema of the leg. British Medical Journal; 318: 1672-1673.
Seaton RA et al (2005) Nurse-led management of uncomplicated cellulitis in the community: evaluation of a protocol incorporating intravenous ceftriaxone. Journal of Antimicrobial Chemotherapy; 55: 5, 764-767.
Thomas S (2008) The Role of Dressings in the Treatment of Moisture-related Skin Damage. World Wide Wounds.
Wingfield C (2009) Lower limb cellulitis: a dermatological perspective. Wounds UK; 5: 2, 13-19.
Wingfield C (2008) Cellulitis: reduction of associated hospital admissions. Dermatological Nursing; 7: 2, 44-50
Cellulitis: Diagnosis and treatment
How is cellulitis diagnosed?
We don’t have a medical test that can diagnose cellulitis. Doctors diagnose it by examining the infected skin and asking questions.
Be sure to tell your doctor about:
A recent injury to your skin
All medical conditions you have
All medications you take
This information can help make sure you get the treatment you need and prevent problems.
To get an accurate diagnosis, some patients need:
Medical tests: While a test cannot tell whether you have cellulitis, testing can tell what germs are causing an infection.
A referral to a dermatologist: If you are seeing a doctor other than a dermatologist, you may be sent to a dermatologist. Cellulitis can look like other skin conditions and infections.
Dermatologists have extensive training in diagnosing the many conditions that can look like cellulitis. An accurate diagnosis is essential to clear your skin condition.
How is cellulitis treated?
If you are diagnosed with cellulitis, treatment is important. It can prevent cellulitis from worsening. It can help you avoid serious medical problems like blood poisoning and severe pain.
To treat cellulitis, doctors prescribe:
Antibiotics: An oral (you take by swallowing) antibiotic can effectively clear cellulitis.
The type of antibiotic you need and how long you’ll need to take it will vary. Most people take an antibiotic for 7 to 14 days. If you have a weakened immune system, you may need to take the antibiotic for longer.
If you stop taking the antibiotic early, there is a risk the antibiotic won’t kill all the bacteria that made you sick. Taking all of the antibiotic exactly as prescribed helps clear cellulitis.
Some people need to take more than one type of antibiotic.
Sometimes, the antibiotic is given through an IV. When this is necessary, a hospital stay is often prescribed. This can help clear severe cellulitis or cellulitis on the face. Most people are hospitalized for just over one week.
Wound care: This is an important part of treating cellulitis. Covering your skin will help it heal. If you need special wound coverings or dressings, you’ll be shown how to apply and change them.
Rest: This can help prevent cellulitis from becoming serious and help your body heal.
Elevation: If you have cellulitis in your leg, keeping your leg elevated can help reduce the swelling and help you heal.
Treatment for another medical condition: If the bacteria got into your body because you have another skin condition like athlete’s foot, it’s important to treat that condition, too.
What is the outcome for someone who gets cellulitis?
With treatment, you should quickly start to see less redness, swelling, pain, and warmth.
If you fail to notice improvement after 24 – 48 hours, let your doctor know.
While cellulitis will clear with treatment, anyone who has had it has a higher risk of getting cellulitis again.
You can find out what helps to prevent this at Cellulitis: How to prevent it from returning.
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Strazzula L, Cotliar J, et al. “Inpatient dermatology consultation aids diagnosis of cellulitis among hospitalized patients: A multi-institutional analysis.” J Am Acad Dermatol. 2015;73(1):70-5.
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