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Cellulitis Content Supplied by NHS Choices
Introduction

Cellulitis is an infection of the deeper layers of skin and the underlying tissue. It can be serious if not treated promptly.

The infection develops suddenly and can spread through the body quickly. Severe infections can spread deep into the body, and can be life threatening.

Most cases are successfully treated with antibiotics at home, although sometimes it needs to be treated in hospital.

This page covers:

Symptoms

When to get medical advice

Treatments

Outlook

Causes

Prevention

Symptoms of cellulitis

Cellulitis causes an area of skin to suddenly become:

  • red
  • hot
  • swollen
  • painful
  • tender

It most often affects the lower legs, but can occur anywhere.

In more severe cases, cellulitis can also be accompanied - and often preceded - by:

  • a high temperature (fever) of 38C (100.4F) or above
  • vigorous shaking (rigors)
  • nausea and vomiting
  • dizziness
  • confusion

These are signs that the infection has spread deeper into the body. Read more about the symptoms of cellulitis.

When to get medical advice

See your GP or visit your nearest minor injuries unit as soon as possible if an area of your skin suddenly turns red, painful and hot.

Early treatment can help reduce the risk of the infection becoming severe.

Call 999 for an ambulance or go to your nearest accident and emergency (A&E) department immediately if:

  • your face or the area around your eye is affected
  • your symptoms are getting rapidly worse
  • you experience other symptoms in addition to the changes in your skin, such as a fever or vomiting
  • you have a weak immune system - for example, because of HIV or chemotherapy - or severe lymphoedema, a condition that causes swelling in the body's tissues
  • a young child or elderly person has possible cellulitis

Treatments for cellulitis

Cellulitis is usually treated with antibiotics. Many infections can be treated with antibiotic tablets at home.

You'll usually be given a seven-day course of tablets, and your symptoms should start to improve after a few days.

Make sure you complete the whole course of medicine you've been given, even if you're feeling better. Contact your GP if your symptoms get worse after a few days or don't improve within a week.

For serious infections, treatment is usually started in hospital. You'll normally be given antibiotics directly into a vein through an injection or a drip.

Many hospitals can then arrange for this treatment to continue at home or in an outpatient clinic. Treatment is usually for seven days.

If the infection responds to treatment quickly, it may be possible to complete the course with antibiotic tablets instead of having injections or a drip.

Read more about how cellulitis is treated.

Outlook for cellulitis

Cellulitis can usually be treated successfully with antibiotics, and most people make a full recovery.

But there is a risk it could cause potentially serious problems, particularly if it's not treated quickly, such as:

Septicaemia and kidney problems can be life threatening and require immediate treatment in hospital.

Causes of cellulitis

Cellulitis is usually caused by a bacterial infection.

The bacteria that cause it often live harmlessly on the skin, but they can lead to an infection if they get into a break in your skin, such as:

In most cases the trigger for the infection is unknown.

The infection isn't normally spread from person to person.

Read about the causes of cellulitis, including information on who's most at risk of the condition.

Preventing cellulitis

If you've had cellulitis before, you're more likely to get it again.

It's not always possible to prevent it, but the following measures may help reduce your risk:

  • use moisturiser if your skin is dry or prone to cracking
  • lose weight if you're overweight - being obese can increase your risk of cellulitis
  • try to ensure any conditions that can increase your risk of cellulitis - such as eczema, athlete's foot, leg ulcers and lymphoedema - are well managed
  • make sure any cuts, grazes or bites are kept clean - wash them under running tap water and cover them with a plaster or dressing
  • wash your hands regularly - particularly when treating or touching a wound or skin condition

If you get cellulitis often or severely, your GP may refer you to a skin specialist called a dermatologist, or an infection specialist, to discuss the option of taking antibiotics on a long-term basis to protect against further infections.

Antibiotics
Antibiotics are medicines that can be used to treat infections caused by microorganisms, usually bacteria or fungi. For example amoxicillin, streptomycin and erythromycin.
Bacteria
Bacteria are tiny, single-celled organisms that live in the body. Some can cause illness and disease and some others are good for you.
Inflammation
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Symptoms

Symptoms of cellulitis develop suddenly and can get worse quickly. It affects the skin and can also cause additional symptoms.

Skin symptoms

Cellulitis causes the affected skin to become:

  • red
  • hot
  • swollen
  • painful
  • tender

There may also be a break in the skin, although this isn't always obvious, and pus or blood-filled blisters.

Any part of the body can be affected.

Commonly affected areas include the lower legs, feet, arms or hands, and sometimes the face, particularly around the eyes.

See your GP or visit your nearest minor injuries unit as soon as possible if an area of your skin suddenly turns red, painful and hot.

Additional symptoms

Cellulitis can also cause additional symptoms that may develop before or alongside the changes to your skin.

These can include:

  • feeling generally unwell
  • feeling sick
  • shivering
  • chills

Occasionally the infection can spread to other parts of the body, such as the deeper layers of tissue, blood, muscle and bone. This can be very serious and potentially life threatening.

Signs the infection has spread include:

  • a high temperature (fever) of 38C (100.4F) or above
  • a fast heartbeat or fast breathing
  • being sick
  • diarrhoea
  • feeling dizzy or faint
  • confusion or disorientation
  • cold, clammy, pale skin
  • unresponsiveness or loss of consciousness

Call 999 or go to your nearest accident and emergency (A&E) department immediately if you have other symptoms in addition to changes to your skin.

Fever
A high temperature, also known as a fever, is when someone's body temperature goes above the normal 37 C (98.6 F).
Causes

Cellulitis is usually caused by a bacterial infection. It occurs when bacteria get into the tissues beneath the skin.

How the infection occurs

The bacteria that cause cellulitis often live harmlessly on the skin. But if the surface of your skin is damaged, they can get into the layers underneath and cause an infection.

The break in the skin may be so small it's not noticeable.

It may be caused by:

Cellulitis isn't normally spread from person to person as the infection occurs deep within the skin and is often caused by bacteria that live on the skin's surface without causing problems.

Increased risk

Anyone can get cellulitis, but you're at an increased risk if:

  • you're obese - you can use the healthy weight calculator to check your weight
  • you have poor circulation in your arms, legs, hands or feet
  • you have a weakened immune system - for example, because of HIV or chemotherapy treatment
  • you have lymphoedema - a condition that causes fluid to build up under your skin
  • you have poorly controlled diabetes
  • you've had cellulitis before
  • you use injected drugs

Ensuring the underlying health conditions mentioned above are well controlled may help reduce your risk of getting cellulitis.

Chronic
Chronic usually means a condition that continues for a long time or keeps coming back.
Immune system
The immune system is the body's defence system, which helps protect it from disease, bacteria and viruses.
Liver
The liver is the largest organ in the body. Its main jobs are to secrete bile (to help digestion), detoxify the blood and change food into energy.
Obesity
Obesity is when a person has an abnormally high amount of body fat.
Veins
Veins are blood vessels that carry blood from the rest of the body back to the heart.
Treatment

Cellulitis can often be treated at home with a course of antibiotics, although severe cases may need to be treated in hospital.

Treatment at home

Antibiotics

If you're treated at home, you'll usually be prescribed antibiotic tablets to take two to four times a day for a week.

A longer course may be needed if your symptoms don't improve after a week or you have an underlying condition that makes cellulitis more difficult to treat, such as lymphoedema.

Commonly prescribed antibiotics include flucloxacillin, amoxicillin, clarithromycin and co-amoxiclav. Possible side effects can include an upset stomach or diarrhoea.

Your symptoms may get worse in the first 48 hours after treatment starts, but should start to improve soon afterwards.

Make sure you complete the whole course of medicine you're given, even if you're feeling better.

Looking after yourself

While you're recovering at home, the following steps can help ease your symptoms and aid your recovery:

  • take paracetamol or ibuprofen for the pain
  • raise the affected body part to reduce swelling - for example, if your leg is affected, rest it on pillows or a chair when you're sitting or lying down
  • try to regularly move the joint near the affected body part, such as your wrist or ankle, to stop it getting stiff
  • drink plenty of fluids to avoid dehydration
  • if you usually wear compression stockings - for example, for lymphoedema - avoid these until you've recovered

When to get medical advice

Contact your GP as soon as possible if:

  • your symptoms get worse after 48 hours
  • your symptoms haven't improved after a week
  • you develop additional symptoms, such as a high temperature (fever) or vomiting

Treatment in hospital

If you need to be admitted to hospital for treatment, you'll be given antibiotics directly into a vein through an injection or a drip (intravenous antibiotics).

Once you've recovered from the initial symptoms, you can usually be treated with antibiotic injections or tablets at home or as an outpatient, rather than staying in hospital.

Antibiotics
Antibiotics are medicines that can be used to treat infections caused by micro-organisms, usually bacteria or fungi. For example amoxicillin, streptomycin and erythromycin.
Fever
A high temperature, also known as a fever, is when someone's body temperature goes above the normal 37 C (98.6 F).
Kidney
Kidneys are a pair of bean-shaped organs located at the back of the abdomen, which remove waste and extra fluid from the blood and pass them out of the body as urine.
Liver
The liver is the largest organ in the body. Its main jobs are to secrete bile (to help digestion), detoxify the blood and change food into energy.
 
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