At a Glance:
- Cellulitis is a bacterial infection of the skin and subcutaneous tissue
- Symptoms of cellulitis include the infected area being red and swollen, painful and warm to the touch. Other symptoms may include fever, swollen glands near the affected area and feeling generally unwell
- Cellulitis may affect any part of the body but it is most common on the lower legs
- Bacteria can enter the subcutaneous tissue through breaks in the skin
- Anyone may be affected by cellulitis but middle aged and elderly people are more at risk than any other group
- If left untreated, cellulitis may spread to other areas of the body, potentially leading to organ damage and even death
- In most cases, cellulitis may be treated simply with a course of oral antibiotics. If these fail to treat the condition, hospitalisation and intravenous antibiotics may be required (or IV antibiotics administered by home nurses). The underlying conditions predisposing to cellulitis may need to be addressed
- There are other conditions which cause redness of the legs, most commonly stasis eczema related to varicose veins and oedema. This normally affects both legs and although the skin is red, the condition is long standing
What is Cellulitis?
Cellulitis is a common but potentially serious bacterial skin infection that affects skin and subcutaneous tissue. The infection is most common in the lower legs and feet but can appear in other areas of the body as well, such as the abdomen, arms or face.
Affected skin typically appears red, inflamed and is typically warm and painful to the touch. The area of redness can spread over a few days. The infection normally enters through cracked or otherwise damaged skin but in some cases undamaged skin may also be affected.
While a number of bacteria may be responsible for cellulitis, the most common causes of the infection are Golden Staph (staphylococcus aureus) and group A beta-haemolytic streptococcus (GAS), the bacteria responsible for strep throat.
These bacteria live on the skin where they are usually harmless, but can enter the body through damage to the skin such as cuts, abrasions, insect bites, punctures (including fresh tattoos), ulcers, blisters and the like. In some cases, a person may develop cellulitis without any noticeable skin damage in the affected area.
Cellulitis may affect anyone of any age or sex, with men and women being affected equally. Middle aged and elderly people appear to be more at risk of developing cellulitis.
Symptoms of Cellulitis
Although cellulitis may occur anywhere on the body, it most typically occurs on the lower legs in the tibia/shin region down to the feet. Typical symptoms of cellulitis include:
- Pain and tenderness in the affected area. The area may be especially sensitive to touch
- The affected area is warm to the touch or radiates heat
- Swelling and redness in the affected area. Skin in the swollen area may appear glossy, waxy or taut
- Swollen glands near the area of the infection (such as in the groin for leg infections or neck in the case of facial infection)
- Fast growing sores or spreading rash in the affected area
- A pus filled abscess may develop develops in the affected area
- Blistering or streaking of the skin (from some sub-species of bacteria with exfoliative toxins)
- Fever
If any of these symptoms develop, it’s important to seek medical attention. Without treatment, cellulitis, in rare cases, may be a life threatening condition as the infection may affect other parts of the body including the bloodstream, lymphatic system and other organs.
If cellulitis spreads beyond the skin and subcutaneous tissues, symptoms may include:
- Chills
- Dizziness and/or lightheadedness
- Drowsiness and general lethargy
- Fatigue
- Muscle aches
- Shivering
- Sweating
If the infection spreads then it may lead to some potentially serious conditions. Depending on where the infection spreads to, complications of cellulitis may include:
- Bacteraemia - if the infection enters the bloodstream it may lead to bacteraemia. While a blood infection may be dangerous in and of itself due to the possibility of sepsis and septic shock, the greatest danger of bacteraemia is how easily the infection can be spread around the body, leading to a host of serious and potentially deadly conditions, including meningitis, pneumonia, endocarditis and osteomyelitis.
- Endocarditis - the endocardium is the inner lining of the heart. Endocarditis is an infection of the endocardium and may lead to heart valve damage, heart murmurs or heart failure. Other complications of endocarditis include stroke, kidney damage and an enlarged spleen.
- Kidney Damage - between a third to nearly half all all cases of acute kidney damage are caused by sepsis or septic shock.
- Liver damage - untreated bacteraemia may lead to severe liver damage greatly affecting quality of life.
- Osteomyelitis - when a bone becomes infected, the inflammation may block blood vessels, starving the affected area of bone of oxygen and other vital nutrients, potentially leading to tissue death. Even if the bone does not die, osteomyelitis may cause a number of debilitating symptoms including bone pain, a reduction in mobility, muscle spasms and excessive sweating. Osteomyelitis requires prolonged courses of IV antibiotics to cure.
- Suppurative Arthritis - also known as pyarthrosis or septic arthritis, suppurative arthritis occurs when an infection enters a joint, leading to inflammation, pain and a reduction in movement.
If you have a swollen red skin rash that causes pain and feels warm to the touch, or any of the other symptoms of cellulitis, schedule an appointment to see a doctor .
What Causes Cellulitis?
Cellulitis is caused by a bacterial infection entering the skin and affecting the skin and subcutaneous tissue. A number of different bacteria may cause cellulitis but the two most common are staphylococcus aureus and group A beta-haemolytic streptococcus. These bacteria commonly live on the skin and are usually harmless but may cause serious problems if they enter tissue or the bloodstream.
While bacterial infection is the direct cause of cellulitis, there are a number of risk factors that may increase the chance of someone developing the condition, such as:
- A suppressed or weakened immune system - diseases, conditions and medications that affect or suppress the immune system, including diabetes, HIV/AIDs and immunosuppressant drugs such as those used for the treatment of autoimmune conditions or organ transplant
- Skin conditions - skin infections, such as tinea, chronic skin disorders such as psoriasis, eczema and dermatitis and other skin conditions such as shingles all increase the risk of the skin being damaged increasing the risk of bacterial infection
- Obesity - being overweight or obese may increase your risk of developing cellulitis
- Diabetes - people living with diabetes frequently exhibit problems with circulation and peripheral neuropathy, making them more prone to foot injuries that may go unnoticed. Poor circulation may reduce the body’s ability to fight off infection
- Previous instances of cellulitis - people who have previously had cellulitis have an increased risk of developing the condition again
- Pregnancy - hormonal changes, weight gain and other changes to the body caused by pregnancy may lead to skin conditions, edema and other issues that may increase the risk of developing cellulitis
- Oedema - swelling caused by excess fluid being trapped in body tissue, most commonly the hands, arms, legs and feet. A number of different factors, including kidney disease, cirrhosis, congestive heart disease, venous insufficiency, lymphatic issues and protein deficiency may lead to oedema
Treatment for Cellulitis
Although there are a number of potentially dangerous complications related to cellulitis, it is typically easily diagnosed. A doctor may be able to simply diagnose the condition through a visual and physical inspection, but they may also request additional blood and imaging tests to see if and how the infection has spread.
Before the development of antibiotics, cellulitis was essentially a death sentence, but now, the majority of cases of cellulitis may be treated with a course of antibiotics. This course may last anywhere between around five days to 14 days depending on the severity, but in many cases the signs and symptoms of cellulitis will disappear or significantly lessen within a few days of the treatment starting. As with all antibiotics, the complete course should be taken even if the symptoms disappear.
If oral antibiotics don’t appear to be working, if the symptoms are severe or widespread or if the patient is experiencing a high fever, they may be hospitalised for treatment with intravenous antibiotics. In rare cases, surgery may be required to drain abscesses or remove damaged, necrotic tissue.
There are no home remedies or over the counter medications for cellulitis. Medical attention and antibiotics are required to treat the condition. Over the counter pain relievers may be used to help control symptoms during treatment.
While there are no home remedies for cellulitis, there are some steps that may be taken to reduce the risk of developing cellulitis, such as:
- Moisturise - keeping your skin moist may prevent your skin from cracking or peeling
- Protect your skin - especially on your hands and feet by wearing appropriate, well fitting shoes and protective gloves if necessary
- Trim fingernails and toenails carefully - be careful not to damage the skin around the nails or cut them too short (ingrown nails are a potential source of infection)
- Don’t ignore superficial infections - don’t ignore athlete’s foot or small infections (such as around insect bites) as these may spread
- Maintain proper hand hygiene - wash your hands with soap and water for 20 seconds, or frequently using hand sanitiser, especially when treating wounds, inspecting skin or preparing food
- Monitor your feet - people living with diabetes should regularly check the condition of their feet for wounds or infections
The earlier cellulitis is diagnosed and treated, the less the risk that it may spread and potentially cause some serious complications. The fastest and easiest way to book healthcare appointments online is through MyHealth1st.