Cellulitis is a bacterial infection of the skin that can cause redness, itching, pain, and swelling—and if it’s not treated promptly by a medical professional, it can become very dangerous.
“The job of the skin is to keep bad things out of your body,” says Arash Mostaghimi, MD, director of dermatology inpatient service at the Brigham and Women’s Hospital in Boston. “But if the skin’s top layer is breached, bacteria can get into the layer beneath it, and it can eventually make its way into the bloodstream.”
The inflammation and swelling associated with cellulitis isn’t the result of the bacteria itself but of the immune system’s reaction to it. “It’s your body’s efforts to fight this infection, by dilating blood vessels and recruiting white blood cells to that area” says Dr. Mostaghimi. “This can make the skin tight and red and hot, and sometimes pus can form beneath the skin, as well.”
Cellulitis can occur anywhere on the body, but it most commonly appears on the arms or legs. Doctors can usually diagnose this condition by identifying its symptoms and trademark characteristics; lab tests aren’t typically needed unless treatment has been already attempted and hasn’t worked. Once cellulitis is diagnosed, doctors usually recommend the following courses of treatment.
Oral antibiotics
The “vast majority” of cellulitis cases can be treated with a short course of oral antibiotics prescribed by a doctor—usually one to two weeks, says Dr. Mostaghimi. Cellulitis is often caused by the common bacteria Streptococci or Staphylococci, so doctors usually prescribe a broad-spectrum drug that is effective against both of these strains.
Most of the time, people start to feel better within a few days of their first antibiotic dose; their skin starts to look better, as well. But any time you take antibiotics, it’s important not to stop until your entire course is gone (or until your doctor tells you that you can stop), even if you feel better sooner. This can prevent the infection from sticking around and coming back later.
Wound cleaning and draining
Sometimes, cellulitis can cause an abscess, or a pus-filled area under the skin. If this happens, doctors will likely drain and clean the wound, then apply a covering to help the wound heal and prevent pus from leaking.
IV antibiotics
In rare cases, cellulitis doesn't get better with oral antibiotics alone. That may be because the infection has already spread to the bloodstream and traveled throughout the body. If this happens, symptoms may include a high fever and chills, along with localized pain and swelling.
In this case, the patient may be hospitalized and IV antibiotics may be needed. People who get cellulitis on their face (called facial cellulitis) or in their eye (called orbital cellulitis) may also need IV antibiotics, according to the American Academy of Dermatology, since these types of cellulitis can be more serious and may not respond as effectively to oral antibiotics.
Cellulitis treatment at home
People who are given antibiotics to treat their cellulitis can also help their healing along by taking proper care of the affected area at home. If cellulitis occurs on an arm or a leg, for example, keeping that limb elevated can help reduce swelling and discomfort.
Over-the-counter anti-inflammatory medicines may also help relieve pain and swelling, says Dr. Mostaghimi. Doctors may recommend covering the affected area, wearing compression garments (like wraps or stockings), or using a cool, damp cloth on the affected skin.
It’s important, however, not to irritate the affected skin further, so ask your doctor about these treatments before trying them yourself. He or she can show you what types of bandages or dressings you should use, and how to clean your skin thoroughly before covering it.
Any time a person is injured or sick, getting enough rest—and practicing relaxation and stress reduction—can also be important parts of the recovery process. Research suggests that skimping on sleep and being subjected to chronic psychological stress can both be detrimental to wound healing.
Ruling out other conditions
If cellulitis isn’t getting better with antibiotics, doctors should make sure that the symptoms aren’t caused by another condition. According to Dr. Mostaghimi, other types of infections are sometimes misdiagnosed as cellulitis, which can delay proper treatment.
“Our research show that when people go to the emergency room or to their primary care doctor and the diagnosis is cellulitis, probably about a third of those cases are incorrect,” says Dr. Mostaghimi. “If you have cellulitis that doesn’t respond to treatment, or that keeps coming back in a surprising way, it may be time to check in and say, ‘Hey, maybe I don’t have this; maybe we should broaden the list of things that this could be.’”
Treating the underlying cause
Doctors don’t always know why someone gets cellulitis. Because it’s typically caused by bacteria that lives on the skin and is usually harmless, it’s not always clear why or how it gets into the body and triggers an infection.
“There are definitely times in which we get a cut or scrape or a splinter and it gets infected, and that can certainly be cellulitis,” says Dr. Mostaghimi. “But a lot of times, we see patients who suddenly got it on their leg or their arm, and we can’t identify a form of entry for the bacteria—it must be something microscopic or something very temporary.”
There are also cases of cellulitis that can be traced to skin conditions like dermatitis or athlete’s foot, which can cause tiny cracks in the skin surface and makes it vulnerable to infection. People who are obese or who have chronic illnesses (and weakened immune systems) may also be at increased risk for skin infections. In these cases, doctors should make sure that they are treating those underlying risk factors, along with the cellulitis, to make sure it does not occur again.
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