What is cellulitis?

We’ve all experienced a few cuts and grazes at certain points in our lives, especially during childhood. Most of these are harmless and heal quickly. And even if a minor cut becomes mildly infected it’s often easy to treat by using antiseptic cream and keeping the cut clean and covered.
 
However, sometimes bacteria that often live harmlessly on your skin can cause an infection if they get deep into your skin and subcutaneous tissue through a cut or another type of break. This infection is called cellulitis, and while most cases are effectively treated with antibiotics sometimes cellulitis can cause serious, even life-threatening, complications. 

 

Is cellulitis painful?

Cellulitis can be painful and often develops suddenly and spreads quickly. It can affect any part of your skin, though most cases affect the lower leg (typically just one leg – this is called lower limb cellulitis). 
 

How long does cellulitis last?

Thankfully most people make a full recovery from cellulitis after seven to 10 days (i), though according to the National Institute of Health and Care Excellent (NICE) it’s common to have repeated episodes of cellulitis, with each episode increasing your chances of having another (ii).
 

Is cellulitis contagious?

Cellulitis isn’t infectious but it is quite common, affecting approximately one in 40 people each year (iii). Cases of cellulitis that need hospital treatment number more than 100,000 a year in England alone (iii). Scientists writing in the medical journal Clinical Microbiology And Infection also claim repeated episodes account for between eight and 49 percent of cases of lower limb cellulitis, with recurrent episodes tending to be more severe and needing longer hospitalisation (iv).
 

What causes cellulitis?

Bacteria that cause cellulitis enter your skin through a break – even breaks that are so small you can barely see them – and penetrate the tissues deeply. Some of the things that can allow bacteria into your skin include:
 

• Cuts and grazes

• Insect bites

• Animal or human bites

• Athlete’s foot and other fungal infections

• Eczema and other conditions that can cause dry, cracked skin

• Burns

• Surgical wounds

• Ulcers

• Puncture wounds

 
Cellulitis is most often caused by bacteria called streptococcus and staphylococcus including a strain of staphylococcus you may have heard of called MRSA (methicillin-resistant Staphylococcus aureus). More rarely, other organisms such as fungi can cause cellulitis – usually in children, people with diabetes and those who have weakened immune systems.
 

Is cellulitis dangerous?

The good news is most cases of cellulitis get better with treatment and don’t cause major complications. So, if you’re otherwise healthy and you’ve been treated quickly, you should be better in about a week or so.
 

Cellulitis symptoms

If you develop cellulitis there’s a good chance it will affect one of your legs, usually somewhere between your knee and your foot, often around the ankle. Other parts of the body can also be affected, including the hands, feet, face (particularly around the eyelids – this is called periorbital cellulitis) and even the eye itself, causing bulging (orbital cellulitis). Orbital cellulitis is very serious and is caused by severe sinusitis. Cellulitis on the back of the elbow can also sometimes develop if you lean on your elbow too much.
 
Cellulitis symptoms include:
 

• Skin that feels warm, painful and tender

• Swelling and tightness

• Skin that looks shiny and smooth 

• Discolouration (light skin becomes red or pink while darker skin turns dark brown, grey or purple) 

• Sores or blisters 

• Fever, swollen glands and general unwellness

• Skin itching (this tends to happen in the later stages when the skin is starting to heal)

 

Who is prone to cellulitis?

We don’t know why cellulitis develops in some people and not others, but we do know there are certain conditions and other factors that can increase your risk of getting it, including:
 

• Older age

• Obesity or being overweight

• Poor circulation in the hands, feet, arms and legs

• Weakened immune system

• Pregnancy 

• Poorly controlled diabetes

• Use of intravenous drugs

• Severe eczema

• Athlete’s foot

• Lymphoedema (this causes swelling in the body, usually the arms or legs)

• Chronic venous insufficiency (a condition where the veins in your legs don’t let blood flow back up to your heart effectively)

• Alcohol dependency

 

What can be mistaken for cellulitis?

Cellulitis isn’t always easy to diagnose because there are several other conditions that look like it. Insect bites, for instance, often cause redness in the affected area caused by the release of the hormone histamine into the skin (an immune system reaction). This can sometimes look like cellulitis, but insect bites are usually itchy while cellulitis doesn’t cause itching until the skin is healing. Other conditions that have been mistaken for cellulitis include:
 

• Varicose eczema 

• Deep vein thrombosis 

• Superficial thrombophlebitis 

• Gout 

• Vasculitis

• Contact dermatitis (another type of eczema) 

 

Cellulitis vs erysipelas

Cellulitis and erysipelas are both skin infections that affect the skin surface and the tissue just below, however, erysipelas often affects the face or a leg and is a milder version of cellulitis as the infection doesn’t get so deep into the skin.
 

Cellulitis treatment

Cellulitis is treated with antibiotics, usually a week’s course of tablets (though if the infection hasn’t cleared after a week you may have to take a second course). Some people who have frequent episodes of cellulitis may be prescribed long-term antibiotics to stop the infections recurring. Severe infections may need hospital treatment, which includes antibiotics through a drip.
 
Your GP may also advise you to take paracetamol or ibuprofen if you’re in pain or have a mild temperature, and to drink plenty of fluids. If you have lower limb cellulitis it’s also a good idea to keep your leg elevated to help prevent or relieve swelling.
 

What are the complications of cellulitis?

When you take medication for cellulitis at an early stage it rarely becomes a serious problem. However people with weakened immune systems – such as those taking medicines for HIV, for instance – can develop more severe infections, even if they take medication early. On the other hand, if it isn’t treated, cellulitis can cause a range of complications – many of which, while rare, can be potentially life-threatening – including:
 

• Abscess (a collection of pus)

• Gangrene (death and decay of body tissue)

• Septicaemia (a potentially life-threatening reaction to an infection, also described as a type of blood poisoning)

• Necrotising fasciitis (often called flesh-eating disease)

• Osteomyelitis (inflammatory bone disease) 

• Endocarditis (an infection that affects the heart)

• Kidney damage (when streptococcus is the infecting bacteria)

• Meningitis (this can be caused by facial erysipelas)

 

How to prevent cellulitis

There are a few simple things you could do that may help reduce your risk of developing cellulitis or a recurrent episode of cellulitis – though it’s not always preventable, particularly in older people and those with weakened immune systems:
 

• Try to keep your skin as clean as possible whenever you can

• Keep your skin well hydrated (use moisturiser regularly to help prevent your skin becoming too dry and cracked)

• If you have an itchy skin condition such as eczema, try not to scratch. Also keep your fingernails short to prevent the damage longer fingernails can cause during scratching

• If you cut yourself, clean the wound under running tap water and use antiseptic cream, then cover the cut with a plaster or other sterile dressing (change the plaster or dressing regularly if it gets dirty or wet)

• Protect yourself against cuts and scrapes at work and while playing sports by wearing appropriate protective clothing and shoes, including gloves if you’re working outside 

• If you develop a skin condition that causes cracks – athlete’s foot, for example – treat it quickly (read our guide [ADD LINK] to find out how to treat athlete’s foot)

• Check your skin regularly for cuts and other signs of injury and treat anything you find promptly if you have a high risk of developing cellulitis

 

How to treat cellulitis at home

Besides taking the antibiotics your doctor has prescribed you for cellulitis there are several things you can do while you’re resting at home that can help relieve your symptoms and speed your recovery:
 

• Keep the affected part of your body raised as often as possible for at least 48 hours, as this will help reduce swelling (and subsequently also pain). For instance, if you have lower limb cellulitis, keep your foot higher than your hip (try lying on a sofa with your foot on the arm of the sofa or sit with your foot on a footstool with several thick cushions).

• If you’re keeping your foot raised, go for regular short walks to keep your circulation working (also move your toes up and down every now and then when you’re lying or sitting).

• Use a cool compress if your skin is feeling particularly hot and painful.

• Drink plenty of fluids to prevent dehydration.

• Keep any dressings you’re using clean and change them regularly (ask your doctor for instructions).

• Avoid wearing compression socks or stockings until your cellulitis has cleared up (these are often used by people with lymphoedema, for instance).

 

Give your immune system a boost

It’s also a good idea to give your immune system a helping hand while it’s hard at work fighting cellulitis. One of the best ways to do this is to eat as healthily as possible, as a healthy diet can help keep your immune system strong. Find out more about eating healthily, including how much you should eat from the different food groups, by taking a look at Public Health England’s Eatwell Guide. 

You may want to consider taking a supplement to support your immune system too. A multivitamin and mineral supplement, for instance, could help support your general health (including that of your immune system). Find out more about these, including the different types that are available, in our guide to multivitamins and daily requirements.

Other supplements you may find useful include:
 

High-strength fish oils

Often linked with heart, brain and eye health; the omega-3 fatty acids found in oily fish are also thought to support immune health (v). One omega-3 fatty acid in particular – namely DHA – has also been found to have benefits for skin that’s affected by eczema (vi), which is a risk factor for cellulitis. 

Fish oil supplements contain omega-3 fatty acids, but vegetarians and vegans can also get their omega-3s from supplements that contain plant organisms called microalgae, which contain the natural triglyceride form of omega-3.
 

Vitamin C  

Immunity is one of the many processes in the human body that needs this important nutrient. Indeed, vitamin C supports a number of functions of the immune system, with deficiency leading to lowered immunity and a higher susceptibility to infections (vii). The human body cannot make vitamin C, so you have to get it from your diet – with good sources including berries, peppers, citrus fruit, broccoli, kiwifruit and peppers – and also from good-quality vitamin supplements (including multivitamins).
 

Zinc  

Another important nutrient for human health, zinc is considered essential for immunity too, and there’s good evidence that zinc deficiency plays a major part in immune dysfunction in humans (viii). One study of zinc deficiency in humans suggests it may result in problems in the way the immune functions, mainly the functions of immune cells called T cells (T lymphocytes) (ix).

You can get zinc by eating foods such as meat, shellfish, legumes, nuts, seeds, dairy foods, eggs and whole grains. If you’re thinking of trying a zinc supplement, look for the mineral in its citrate form, as this is believed to be absorbed by the body more easily than some other forms. Alternatively you may want to consider trying a multivitamin that contains zinc.
 

Live bacteria 

The millions of microorganisms and bacteria that live in your digestive system are thought to play a key role in immune response, with up to 80 percent of immune tissue found within the digestive tract itself (x). Experts have also found that one type of live bacteria may eliminate staphylococcus, which is one of the two main types of bacteria that cause cellulitis (xi). Food sources of acidophilus and other types of live bacteria include yoghurt, kefir, sauerkraut, miso and tempeh. You can also find beneficial amounts of live bacteria in good-quality supplements.
 

Find out more

Cellulitis can be quite unpleasant and have an impact on your quality of life, putting you out of action for days or sometimes weeks. Getting it treated as early as possible is important, as it could help you get back on your feet again more quickly. There are also measures you can take to make an episode of cellulitis less likely, as well as soothing self-help methods to try if you do develop the infection.
 
In the meantime there’s lots more information about keeping your skin and immune system healthy, as well as details of a wide range of other health problems and ailments in our pharmacy health library. 

 

References:

1. Available online: https://www.nhs.uk/conditions/cellulitis/

2. Available online: https://cks.nice.org.uk/topics/cellulitis-acute/background-information/prevalence/

3. Available online: https://bjgp.org/content/bjgp/68/677/595.full.pdf

4. Canon J. et al., Epidemiology and risk factors for recurrent severe lower limb cellulitis: a longitudinal cohort study. Clin Microbiol Infect. 2018 Oct;24(10):1084-1088. Available online: https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(18)30141-1/fulltext

5. Gutierrez . S, Sbahn. SL, Johansson. ME. Effects of Omega-3 Fatty Acids on Immune Cells. Int J Mol Sci. 2019 Oct;20(20):5028.Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6834330/

6. Koch C. et al., Docosahexaenoic acid (DHA) supplementation in atopic eczema: a randomized, double-blind, controlled trial. Br J Dermatol. 2008 Apr;158(4):786-92. Available online: https://onlinelibrary.wiley.com/doi/10.1111/j.1365-2133.2007.08430.x

7. Carr. AC., Maggini S., Vitamin C and Immune Function. Nutrients. 2017 Nov;3;9(11). Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5707683/

8. Keen. CL., Gershwin ME., Zinc deficiency and immune function. Annu Rev Nutr. 1990;10:415-31. Available online: https://www.ncbi.nlm.nih.gov/pubmed/2200472

9. Prasad AS., Zinc in Human Health: Effect of Zinc on Immune Cells. Mol Med. 2008 May-Jun;114(5-6). Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2277319

10. Vighi G. et al., Allergy and the gastrointestinal system. Clin Exp Immunol. 2008 Sep ;153(Suppl 1): 3-6. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2515351/

11. Piewngam P. et al., Pathogen elimination by probiotic Bacillus via signal interference. Nature. 2018 ;562, 532-537. Available online: https://www.nature.com/articles/s41586-018-0616-y
     

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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.

 

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