Cellulitis (sel-u-LI-tis) is a potentially serious bacterial infection of your skin. It appears as a swollen, red area of skin that feels hot and tender, and it may spread rapidly.
Skin on the lower legs or face is most commonly affected by this infection, though cellulitis can occur on any part of your skin. The infection may only be superficial, but it may also affect the tissues underlying your skin and can spread to your lymph nodes and bloodstream.
Left untreated, the spreading bacterial infection may rapidly turn into a life-threatening condition. That’s why it’s important to recognize the signs and symptoms of cellulitis and to seek immediate medical attention if they occur.
Cellulitis may result in skin that is:
- Red
- Swollen
- Tender
- Warm
The changes in your skin may be accompanied by a fever. Over time, the area of redness tends to expand. Small red spots may appear on top of the reddened skin, and less commonly, small blisters may form and burst.
Cellulitis occurs when one or more types of bacteria enter through a crack or break in your skin. The two most common types of bacteria that cause cellulitis are streptococcus and staphylococcus.
Although cellulitis can occur anywhere on your body, the most common location is the legs, especially near your shins and ankles. Disrupted areas of skin, such as where you’ve had recent surgery, cuts, puncture wounds, an ulcer, athlete’s foot or dermatitis, serve as the most likely areas for bacteria to enter.
Certain types of insect or spider bites also can transmit the bacteria that start the infection. Areas of dry, flaky skin also can be an entry point for bacteria, as can swollen skin.
Several factors can place you at greater risk of developing cellulitis:
- Age. As you age, your circulatory system becomes less effective at delivering blood — with its infection-fighting white blood cells — to some areas of your body. As a result, skin abrasions may lead to infections such as cellulitis where your circulation is poor.
- Weakened immune system. Illnesses that result in a weakening of your immune system leave you more susceptible to infections such as cellulitis. Examples of these illnesses include chronic lymphocytic leukemia and HIV infection. Taking immune-suppressing drugs, such as prednisone or cyclosporine, also can leave you vulnerable to infections. Immune-suppressing drugs are used to treat a variety of illnesses and to help prevent rejection in people who receive organ transplants.
- Diabetes. Having diabetes not only increases your blood sugar but also impairs your immune system and increases your risk of infections. Your skin is one of the many areas of your body that becomes more susceptible to infection. Diabetes may also lead to chronic ulcers of your feet. These ulcers can serve as portals of entry for bacterial infections.
- Chickenpox and shingles. These common viral diseases typically cause broken blisters on the skin that can serve as potential entry points for bacterial invasion and infection.
- Chronic swelling of your arms or legs (lymphedema). Swollen tissue may crack, leaving your skin vulnerable to bacterial infection.
If you have a rash that’s red, swollen, tender and warm — and it’s expanding — try to see your doctor the same day. If a fever or pain accompanies the rash, or the rash is changing rapidly, seek emergency care. It’s important to identify and treat cellulitis early because the condition can cause a serious infection to spread rapidly throughout your body.
The appearance of your skin will help your doctor make a diagnosis. Your doctor may also suggest blood tests, a wound culture or other tests to help rule out a blood clot deep in the veins of your legs. Cellulitis in the lower leg is characterized by signs and symptoms that may be similar to those of a clot occurring deep in the veins, such as warmth, pain and swelling.
This reddened skin or rash may signal a deeper, more serious infection of the inner layers of skin. Once below the skin, the bacteria can spread rapidly, entering the lymph nodes and the bloodstream and spreading throughout your body.
In rare cases, the infection can spread to the deep layer of tissue called the fascial lining. Flesh-eating strep, also called necrotizing fasciitis, is an example of a deep-layer infection. It represents an extreme emergency.
Your doctor may prescribe an oral antibiotic to treat cellulitis. You’ll likely recheck with your doctor one to two days after starting an antibiotic, and take it for about 10 days. In most cases, signs and symptoms of cellulitis disappear after a few days. If they don’t clear up, if they’re extensive or if you have a high fever, you may need to be hospitalized and receive antibiotics through your veins (intravenously).
Usually, doctors prescribe a drug that’s effective against both streptococci and staphylococci. An example is cephalexin (Keflex, Keftab). Your doctor will choose an antibiotic depending on your circumstances.
To help prevent cellulitis and other infections, follow these measures any time you have a skin wound:
- Wash your wound daily with soap and water. Do this gently as part of your normal bathing.
- Apply an antibiotic cream or ointment. For most surface wounds, a single- or double-antibiotic ointment provides adequate protection.
- Cover your wound with a bandage. This helps keep the wound clean and bacteria out. If you have draining blisters, keep them covered until a scab forms.
- Change bandages often. Change them at least daily or whenever the bandage becomes wet or dirty.
- Watch for signs of infection. Redness, pain and drainage all signal possible infection, and the need for medical evaluation. People with diabetes and those with poor circulation need to take extra precautions to prevent skin wounds and treat any cuts or cracks in the skin promptly. Good skin care measures include:
- Moisturize your skin regularly. Lubricating your skin helps prevent cracking and peeling.
- Trim your fingernails and toenails carefully. Take care not to injure the surrounding skin.
- Protect your hands and feet. Wear appropriate footwear and gloves.
- Promptly treat any superficial skin infections, such as athlete’s foot. Superficial infections can spread.