Cellulitis, not to be confused with cellulite, is a bacterial infection of the dermis—the deep layer of skin—as well as the subcutaneous tissues, the fat and soft tissue layer that are under the skin.
Some types of bacteria are naturally present on the skin and do not normally cause any harm. However, if the bacteria go deep into the skin, they can cause an infection. Bacteria can enter through cuts, grazes, or bites.
People with conditions, such as eczema or psoriasis may have a higher risk of developing cellulitis.
- Cellulitis occurs when bacteria enter the deep layers of skin through a wound or sore.
- The legs are most commonly affected.
- Risk factors include a reduced immune response and obesity.
- Diagnosis of cellulitis is relatively easy from observing external symptoms.
- Cellulitis nearly always responds rapidly to antibiotics.
What is cellulitis?
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Cellulitis is a bacterial infection of the deeper layers of the skin. It can start suddenly, and it can become serious if not treated.
If it spreads deeper into the body, it can be life-threatening.
Early treatment with antibiotics is usually successful. Most people can be treated at home, but sometimes they need to spend time in the hospital.
Cellulitis can affect any part of the body, but it is most likely to appear in the lower legs. It is a painful condition.
Treatment
The following treatments are commonly recommended for cellulitis:
Medication
Cellulitis nearly always responds rapidly to antibiotics. Some people experience a slight worsening of the reddening of the skin at the start of antibiotic treatment, which usually subsides within a couple of days.
However, anyone who experiences fever, vomiting, or any worsening of their symptoms after starting antibiotic treatment, should contact a doctor immediately. Many different types of antibiotics can be used to treat cellulitis. Which type the doctor prescribes will depend on what type of bacteria the doctor suspects has caused the infection.
Antibiotics are normally taken for 5-10 days, but treatment might last 14 days or more in some cases.
Treatment in the hospital
Some people with severe cellulitis may require hospital treatment, especially if the cellulitis is deteriorating, if the person has a high fever, is vomiting, fails to respond to treatment, or has recurrences of cellulitis.
Most people who are treated in hospital will receive their antibiotic through a vein in their arm (intravenously, using a drip).
Types
Cellulitis can be classified into different types, according to where it appears.
This can be:
- around the eyes, known as periorbital cellulitis
- around the eyes, nose, and cheeks, known as facial cellulitis
- breast cellulitis
- perianal cellulitis, occurring around the anal orifice
However, the most common location is the lower legs.
Symptoms
The affected area will become:
- warm
- tender
- inflamed
- swollen
- red
- painful
Some people may develop blisters, skin dimpling, or spots. They might also experience a fever, chills, nausea, and shivering.
Lymph glands may swell and become tender. If the cellulitis has affected the person's leg, the lymph glands in their groin may also be swollen or tender.
Causes
Bacteria from the Streptococci and staphylococci groups are commonly found on the surface of the skin and cause no harm, however, if they enter the skin, they can cause infection.
For the bacteria to access the deeper skin layers, they need a route in, which is usually through a break in the skin. A break in the skin can be caused by:
- ulcers
- burns
- bites
- grazes
- cuts
- some skin conditions, such as eczema, athlete's foot, or psoriasis
Some people develop cellulitis without being able to identify a break in the skin.
Risk factors
The following risk factors increase the likelihood of cellulitis.
- Leg swelling (edema): This raises the chances of developing cellulitis.
- Weakened immune system: Including people who are undergoing chemotherapy or radiotherapy, those with HIV or AIDS, and older adults.
- Diabetes: If the diabetes is not properly treated or controlled, a person's immune system can be weaker, or they may have circulatory problems, which can lead to skin ulcers.
- Blood circulation problems: People with circulation issues may develop skin infections.
- Other skin infections: Conditions, such as chicken pox and shingles may cause skin blisters. If the blisters break, they can become ideal routes for bacteria to get into the skin.
- Lymphedema: This condition causes swollen skin that is more likely to crack. Cracks in the skin may become perfect entry routes for bacteria.
- Previous cellulitis: A person who has had cellulitis before has a higher risk than others of developing it again.
- Intravenous drug users: Drug addicts who do not have access to a regular supply of clean needles are more likely suffer from infections deep inside the skin.
Diagnosis
Diagnosis is usually fairly straightforward and does not generally require any complicated tests. A doctor will examine the individual and assess their symptoms.
Most cases of cellulitis are caused by streptococci and staphylococci, but other conditions, such as Lyme disease, may look like cellulitis, so it is important to follow up with a doctor after diagnosis.
The doctor may take a swab, or sample, if there is an open wound. This can help them identify what type of bacteria is causing cellulitis.
However, these samples are easily contaminated due to the multiple types of bacteria that live on the skin all the time.
A small percentage of patients may have serious complications that include:
- Blood infection and sepsis: If the bacteria reach the bloodstream, the person has a higher risk of developing sepsis. A person with sepsis may have a fever, accelerated heartbeat, rapid breathing, low blood pressure (hypotension), dizziness when standing up, reduced urine flow, and sweaty, pale, cold skin.
- Infection moving to other regions: This is very unusual, but the bacteria that caused the cellulitis can spread to other parts of the body, including muscle, bone, or the heart valves. If this happens, the person needs treatment immediately.
- Permanent swelling: People who do not receive treatment for their cellulitis are at higher risk of having a permanent swelling in the affected area.
In most cases, cellulitis treatment is effective, and the person will not experience any complications.
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