Cellulitis

Cellulitis is a bacterial infection of the skin. Bacteria get into the skin through a cut, scrape, or other wound. Cellulitis can also affect the deeper layers of connective tissue beneath your skin and, in severe cases, spread to your lymph nodes.

Cellulitis most often affects the legs, but it may also affect the arms, face, and scalp. Most times, taking antibiotics cures cellulitis. However, some people can have serious complications. Without treatment, it can become life-threatening.

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Signs and Symptoms

• Pain and tenderness
• Edema, swelling caused by fluid buildup
• Redness of the skin
• Skin that is warm to the touch
• Fever
• Chills

What Causes It?

Cellulitis is caused by bacteria, most often streptococcus or Staphylococcus aureus, which get into the body through a break in the skin:

• Cuts
• Insect bites
• Burns
• Surgical incisions
• IV catheters
• Dermatitis

Methicillin-resistant staphylococcus aureus (MRSA) infection is a more serious type of staph infection and is on the rise. Erysipelas, a type of cellulitis involving the lymph system, is often preceded by an upper respiratory infections. Infants, young children, and the elderly are most likely to get erysipelas, which is generally caused by streptococcal infection.

Who's Most At Risk?

You are at risk for developing cellulitis if you have the following:

• Older age. As your circulation grows weaker with age, it is easier for cuts and scrapes to get infected.
• Diabetes.
• Chickenpox and shingles.
• Lymphedema. Swelling of arms or legs, which may cause skin to crack.
• Fungal infections of the feet, which can also cause cracks in the skin.
• Dirty wounds.
• A weakened immune system.
• A general infection.

What to Expect at Your Provider's Office

If you have symptoms of cellulitis, you should see your doctor right away. If you have a fever with a rash, go to the emergency room. Your health care provider will do a thorough physical examination to see what is causing the condition and which antibiotic to prescribe. Your provider may also order blood tests and imaging.

Treatment Options

Prevention

To help prevent cellulitis:

• If you have a cut or scrape, wash the area gently with clean water. Apply an antibiotic cream or ointment, and cover the area with a bandage. Change the bandage every day and watch for signs of infection.
• If you have diabetes or circulatory problems, check your hands and feet daily for scrapes or cuts, or a fungus such as athlete's foot. Keep your skin moisturized and do not go barefoot.
• In patients with recurrent cellulitis, penicillin may help prevent subsequent attacks.

Treatment Plan

Cellulitis must be treated with antibiotics. To help ease pain, raise the affected arms or legs, keep still, and apply cool, wet, sterile bandages. If your symptoms are not better after a few days, you may need hospitalization so doctors can give you antibiotics intravenously (IV).

Drug Therapies

Your health care provider will prescribe antibiotics for your infection, as well as pain relievers if needed. Your doctor may prescribe an antibiotic that works against both staph and strep, such as cephalexin (Keflex). It is important to take the entire course of antibiotics, even if your symptoms get better before you finish.

Surgical and Other Procedures

If antibiotics do not work, you may need surgery to drain infected tissue.

Complementary and Alternative Therapies

If you have cellulitis, you need to take antibiotics. It can spread rapidly, so you should start antibiotics as soon as possible. Although some alternative therapies may reduce the risk of getting cellulitis, or ease some of the symptoms when used along with conventional care, most haven't been tested in scientific studies.

You should never treat cellulitis with alternative therapies alone. It is important to tell your doctor if you are taking any herbs or supplements because some may interfere with antibiotics.

Nutrition

The following supplements may strengthen the immune system and help skin heal:

• Vitamin C. Vitamin C can potentially interfere with certain medications, including blood-thinning medications and some chemotherapy agents. Speak with your physician.
• Vitamin E.
• Zinc.
• Probiotic supplement (containing Lactobacillus acidophilus). For gastrointestinal and immune health. Taking antibiotics can upset the balance between good and bad bacteria in your gut and cause diarrhea. Taking probiotics, or "friendly" bacteria, helps restore the right balance. People with weakened immune systems, or those who take drugs to suppress their immune systems, should ask their doctor before taking probiotics.

Scientists have not studied the way individual nutrients may treat cellulitis, however, flavonoids -- chemicals in fruits, such as citrus, blueberries, grapes; in vegetables, including onions; and in tea and red wine -- seem to help reduce lymphedema, and the risk for cellulitis. The flavonoid quercetin is available as a supplement. Ask your doctor before taking quercetin, because it may interact with a number of medications, including blood thinners. Very high doses have been associated with kidney damage, so DO NOT take quercetin for more than 2 months without taking a break.

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of your provider.

Cellulitis should be treated with antibiotics. There are no scientific studies showing that any herbs treat cellulitis, but the following herbs may help strengthen the immune system and kill bacteria on the skin. Never put any herbal preparations on an open wound without asking your doctor first. Be sure to tell your doctor about any herbs you use, because some can interfere with taking antibiotics.

Taken by mouth:

• Echinacea (Echinacea spp.). Used to strengthen the immune system. It may also be applied to the skin as a gel or cream containing 15% juice of the herb to treat inflammatory skin conditions. People with autoimmune diseases, such as rheumatoid arthritis or lupus, or those who take drugs to suppress their immune systems, should not take echinacea. Some people can be allergice to Echinacea.
• Pycnogenol (Pinus pinaster). An extract of the bark of a particular type of pine tree, helps promote skin health. People with autoimmune diseases, such as rheumatoid arthritis or lupus, or those who take drugs to suppress their immune systems, should not take Pycnogenol. High doses of Pycnogenol may increase the risk of bleeding in certain conditions.
• Thyme (Thymus vulgaris). Thyme may have antibacterial and antifungal properties, although there is no evidence that it helps treat cellulitis specifically. Thyme can increase the risk of bleeding. Ask your doctor before taking thyme if you take blood-thinning medications, such as warfarin (Coumadin) or aspirin, and never take oil of thyme, which can be toxic.
• Gotu kola (Centella asiatica). In a few studies, gotu kola seems to help wounds heal and reduce risk of infection. Gotu kola interacts with a number of medications, so be sure to ask your doctor before taking it. DO NOT take gotu kola if you experience anxiety or have high blood pressure. Gotu kola can interact with many medications that are processed by the liver, and may raise the risk of liver damage. Gotu kola can also interact with sedative medications, including clonazepam (Klonopin), lorazepam (Ativan), phenobarbital (Donnatal), and zolpidem (Ambien). To be safe, ask your doctor before taking gotu kola.

Applied to the skin -- use these only under a doctor's supervision:

• Yarrow (Achillea millefolium). Approved in Great Britain for skin infections and inflammation. It is applied to the skin.
• Goldenseal root (Hydrastis canadensis). Which has anti-inflammatory and antibacterial properties, and slippery elm (Ulmus fulva), an antiseptic, may be made into a paste and placed on the affected area 2 times per day.
• Calendula flower (Calendula officinalis). Approved in Germany for topical application to leg ulcers, open wounds that can readily become infected.
• Tea tree oil (Melaleuca alternifolia). Has antibacterial and antifungal properties. Some studies suggest tea tree oil may help fight athlete's foot and prevent minor cuts and scrapes from becoming infected.
• Fenugreek seed (Trigonella foenum-graecum). Which contains flavonoids, is approved in Germany for external use on skin inflammation and infections.

Homeopathy

Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may recommend the following remedies for the treatment of cellulitis based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type, includes your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

• Apis mellifica. For swelling with a puffy appearance that worsens with heat and pressure, especially in the afternoon, and is better with cold applications, open air, movement, and sitting upright.
• Cantharis. For restless and anxious individuals. It may be used for children. Cantharis is only available under the direction of a licensed homeopath.
• Lachesis. For symptoms that tend to be worse on the left side of the body and during and immediately after sleep.
• Mercurius. For people who are bothered by both heat and cold, and are often trembling and impulsive.
• Rhus toxicodendron. For people who are restless and anxious with itching that tends to worsen at night but is relieved by warm compresses or pressure.
• Sulphur. For hot, burning skin with itching that worsens at night and with washing.

Seek immediate medical attention if fever and swelling do not subside after 24 hours.

Acupuncture

Acupuncture and other traditional Chinese medicine practices may help with the underlying cause of cellulitis, and may strengthen the immune system. However, no scientific studies have investigated whether they work specifically for cellulitis. The practitioner should be very careful when piercing skin that may be infected, because there is a risk of spreading the infection further. Talk to your doctor first and use a qualified acupuncturist with experience treating infectious skin disease.

Massage

DO NOT use massage if you have an active infection. Massage that promotes lymph drainage, when used with compression and exercise, may help prevent cellulitis.

Prognosis and Possible Complications

Antibiotics usually cure cellulitis. While complications are rare, they can be serious and even life threatening if the infection spreads to the blood. Complications are more common in very young children, the elderly, or in people who have weakened immune systems.

Possible complications include abscesses, gangrene, and thrombophlebitis (inflammation of superficial veins). Some people are prone to have cellulitis come back, often in the same area, leading to permanent skin changes. Gangrene may cause the loss of a limb.

Following Up

Your health care provider should see you periodically to make sure you have no complications.

Supporting Research

Belcaro G, Cesarone MR, Errichi BM, et al. Diabetic ulcers: microcirculatory improvement and faster healing with pycnogenol. Clin Appl Thromb Hemost. 2006;12(3):318-323.

Bernard P. Management of common bacterial infections of the skin. Curr Opin Infect Dis. 2008;21(2):122-128.

Betts J. The clinical application of honey in wound care. Nurs Times. 2008;104(14):43-44.

Biswas TK, Mukherjee B. Plant medicines of Indian origin for wound healing activity: a review. Int J Low Extrem Wounds. 2003;2(1):25-39.

Blum CL, Menzinger S, Genne D. Cellulitis: clinical manifestations and management. Rev Med Suisse. 2013;9(401):1812-1815.

Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. 3rd ed. New York, NY: Penguin Putnam; 1997:320, 331-335, 341, 345.

Dursun N, Liman N, Ozyazgan I, et al. Role of thymus oil in burn wound healing. J Burn Care Rehabil. 2003;24:395-399.

Ferri FF. Cellulitis. Ferri FF, ed. Ferri's Clinical Advisor 2017. 1st ed. Philadelphia, PA: Elsevier; 2017:258-259.e2.

Keller KL, Fenske NA. Uses of vitamins A, C and E and related compounds in dermatology: a review. J Am Acad Dermatol. 1998;39(4 Pt1):611-625.

Maeda Y, Loughrey A, Earle JA, et al. Antibacterial activity of honey against community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA). Complement Ther Clin Pract. 2008;14(2):77-82.

Mortimer PS. Therapy approaches for lymphedema. Angiology. 1997;48(1):87-91.

Pasternack MS, Swartz MN. Cellulitis, necrotizing fasciitis, and subcutaneous tissue infections. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 95.

Ragi J, Pappert A, Rao B, Havkin-Frenkel D, Milgraum S. Oregano extract ointment for wound healing: a randomized, double-blind, petrolatum-controlled study evaluating efficacy. J Drugs Dermatol. 2011;10(10):1168-1172.

Rashed F, Cannon A, Heaton PA, Paul SP. Diagnosis, management and treatment of orbital and periorbital cellulitis in children. Emerg Nurse. 2016;4(1):30-35.

Savage MW, Pottinger JM, Chiang HY, Yohnke KR. Bowdler NC, Herwaldt LA. Surgical site infections and cellulitis after abdominal hysterectomy. Am J Obstet Gynecol. 2013;209(2):108.e1-10.

Thomas KS, Crook AM, Nunn AJ, et al. Penicillin to prevent recurrent leg cellulitis. N Eng J Med. 2013;368(18):1695-1703.

Ullman D. Homeopathic Medicine for Children and Infants. New York, NY: Penguin Putnam; 1992:147, 167-168, 214-216.

Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Penguin Putnam; 1995.

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Review Date: 11/20/2016  

Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network. Also reviewed by the A.D.A.M. Editorial team.

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