Treatment Options for Cellulitis

Cellulitis is a common bacterial skin infection resulting in redness, pain, swelling, and discoloration. In America alone, 14 million suffer the infection each year. The affected area swells and feels warm and soft to the touch. Appearing red on light skin, the skin may appear brown on dark skin. The skin may look pitted or develop blisters. Fever and chills may occur. Some other skin infections are erysipelas, folliculitis, and carbuncles.

What exactly happens in cellulitis?

Bacteria penetrate from the skin surface through broken skin like a cut or wound. Cellulitis affects the dermis below the epidermis, the top skin layer. The dermis has several components, like connective tissue and blood vessels. Further, the dermis has oil, sweat glands, nerves, and hair follicles. Rarely, cellulitis gets deeper, and muscle tissue and bone suffer.

Types of cellulitis

Cellulitis can break out in any part of the skin that envelops the whole body as the largest organ. Children may get it on the neck and face, while adults may be affected in the legs.

  • Periorbital cellulitis affects the skin around the eyes

  • Breast cellulitis

  • Facial cellulitis affects the cheeks and, nose, eyes too

  • Perianal cellulitis affects the anal region

Who are at risk most?

Cellulitis mostly affects children and those with pre-existing skin conditions like athlete’s foot. Weak immune systems and those with wounds stand greater risks of contracting cellulitis. Insect and animal bites could lead to infection. The obese, diabetes sufferers, and those with chronic swellings are more exposed to the risk.

Skin injuries like cuts and surgical wounds might allow the bacteria to enter deep. Eczema also results in the skin cracking that bacteria enter through. Weak immunity cannot keep the infection away. Lymphedema is the swollen condition of the arms and legs that are exposed.


The skin infection or subcutaneous tissue is caused primarily by streptococci or staphylococci bacteria. The bacteria that reside on the skin can enter deeper through the broken skin.

Is cellulitis dangerous?

Normally responding well to antibiotic treatments if treated early, cellulitis should not be neglected. Usually affecting the lower legs and feet, untreated cellulitis could spread over the body or face and get serious. While starting with skin bacteria entering through broken skin, the infection could enter the lymph nodes and bloodstream. Untreated cellulitis could become life-threatening. Early action and medical help should be sought, and treatment should commence soon.

Can cellulitis be infectious?

The infection usually does not spread from one person to another. The bacteria on the person’s skin surface succeed in entering deeper skin layers via a cut or scratch. The possibility of communicating the infection to others arises with an open wound and pus in the infected area.


A doctor will usually know from the sight of the skin that it is cellulitis. The conventional indicators are redness and swelling, warmth, and possibly pus. An abscess is indicated by pus. Swollen glands may be the lymph nodes. The red area may be demarcated with a pen and examined later to see if the infection has spread further. If the legs or feet suffer, checking between the toes may reveal broken skin where bacteria enter.

Since similarities may exist between different skin conditions, blood tests or other tests help clarify. No specific medical test is used to diagnose cellulitis. Lab tests confirm what type of bacteria is causing the infection. Lab tests to confirm bacterial infection include a blood culture, CBC or complete blood count, and culture of discharge in the affected skin. If the infection is not cellulitis, it requires additional testing or a biopsy.


The staphylococcus (“staph”) and the streptococcus (“strep”) bacteria usually cause cellulitis. They are called gram-positive because of a thick cell wall. The antibiotics target them. Penicillin and ampicillin are some common antibiotics. If antibiotics that cover Gram-positive and Gram-negative bacteria are prescribed, they might be clindamycin or doxycycline. Amoxicillin is among others.

The initial treatment consists of oral antibiotics. Start with the prescribed oral antibiotic and wait for 3 days to see the response. Improvements commence early after the course is commenced. The course should be completed even if improvement is observed. The antibiotics may be spread over 5 or 10 days. By that time, the symptoms should gradually disappear. The redness and swelling gradually decrease and disappear. With a weak immune system, it might be a longer course of antibiotics.

If the cellulitis does not respond to oral antibiotics, it means an intense attack. High fever may be present. Hospital treatment will be required. Intravenous antibiotics will be administered for greater impact. Meanwhile, relieve the pain and inflammation with a damp cloth on the area. Take a pain reliever. Elevate the affected part. Compression wraps may help. Take the doctor’s advice.

MRSA infections

If the infection is Methicillin-resistant Staphylococcus aureus, the antibiotics that treat staph infections may be ineffective. MRSA cases are on the increase, and many are found in hospitals. According to a specialist, it is a concern, particularly if an abscess or pus is found. Risk factors are injected drugs. Trimethoprim-sulfamethoxazole, clindamycin, or doxycycline covers MRSA. Vancomycin commences the treatment. If the infection is very severe, piperacillin-tazobactam or meropenem is added.

Treating underlying conditions

If diabetes or cancer, HIV or AIDS, is present, the cellulitis danger increases. Lymphedema or peripheral vascular disease are other conditions that may increase the risk. Treating such conditions well decreases the risk of further cellulitis attacks. Try to lose weight if obese since it increases the cellulitis risk too.

Recurring cellulitis

If all the treatment options fail and several episodes of cellulitis occur in the year, prophylactic antibiotics may be administered. It prevents infection, for a year. Oral penicillin or erythromycin may be prescribed longer, 6 months. Alternatively, intramuscular benzathine penicillin may be given every 2 or 4 weeks.

Surgery if warranted

If an abscess has formed, gangrene or pus, it needs to be surgically removed. An incision is made, and the pus is released. Antibiotics are not needed but may be required in a systemic infection or necrotizing fasciitis, which can get serious. Surgery removes the dead tissue, and intravenous antibiotics are administered in such a case. It is thought that group A streptococcus bacteria cause necrotizing fasciitis.

Early action is wise. Mostly, cellulitis is a minor bacterial skin infection that disappears within days with oral antibiotics. Since it could worsen with underlying conditions, quick diagnosis and treatment by a professional are important.

Updated on: 23-Feb-2023


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