cellulitis flare ups

Overview

Cellulitis is a bacterial infection that affects the deeper layers of the skin. It usually starts as a red, swollen, painful area on the skin, often on the lower legs, and can spread quickly. A 'flare-up' means another episode of this infection, sometimes in the same area as before.

Cellulitis is one of the most common skin infections that need medical care. Recurrent episodes are not unusual — around one in five people who have had cellulitis will experience a repeat episode.

It can affect anyone, but it is more common in older adults, people with poor circulation, diabetes, a weakened immune system, or breaks in the skin. People who have had cellulitis before are at higher risk of another episode.

Symptoms

Common symptoms

• Red, hot, swollen skin that feels tender or painful
• A spreading area of redness, often with a poorly defined edge
• Tight, glossy, stretched appearance of the skin
• Fever or feeling generally unwell
• Blisters or skin dimpling
• Pain in the affected area

Symptoms in children

• Irritability or crying during nappy changes or when touching the skin
• Fever, flushing, or being unusually tired
• A skin area that is red, swollen, warm, or painful
• Being less hungry or less active than usual

Symptoms in older adults

• Confusion or drowsiness can be a sign of a severe infection
• The skin may appear less red, making it harder to spot
• Pain or swelling in a limb can be mistaken for a joint problem
• Fever may be absent or low

Causes

Main causes

• Bacteria entering through a break in the skin, such as a cut, scrape, insect bite, ulcer, or itchy rash
• The most common culprits are Streptococcus and Staphylococcus bacteria that live harmlessly on the skin
• If you have already had cellulitis, the same bacteria may re-infect damaged skin or an area with swelling

Risk factors

• Previous cellulitis
• Lymphoedema or chronic swelling of a limb
• Skin breaks, athlete's foot, eczema, or insect bites
• Poor circulation, diabetes, or obesity
• A weakened immune system
• Intravenous drug use

When to see a doctor

See a doctor urgently if:

• If you think you have cellulitis, especially if you also have fever, chills, or very fast-spreading redness
• If you have cellulitis on your face or around your eye
• If you have diabetes or a weakened immune system

Book a routine appointment if:

• If you have had cellulitis before and notice early signs, so you can get prompt treatment
• If you have skin breaks or swelling that keep recurring

Diagnosis

Your doctor or nurse will listen to your symptoms and examine the affected area. They will look for typical signs like redness, heat, swelling, and tenderness, often on one side of the body.

Tests that may be done

• No test is usually needed
• Sometimes a small sample from the skin or a blood test may be taken if the infection is severe or keeps returning
• If you have repeated flare-ups, your doctor may check for underlying causes like circulation problems or skin conditions

What to expect at your appointment

You may be prescribed a course of antibiotics. Your doctor will also advise you to keep the area clean and raised. They may arrange a follow-up to make sure the infection is clearing.

Treatment

Cellulitis is treated with antibiotics. The earlier you start, the more quickly the infection clears. You may be sent home with medicine, but if the infection is serious or you cannot take antibiotics by mouth, you may need hospital care.

Self-care at home

• Take your antibiotics exactly as prescribed, even if you feel better
• Keep the affected limb raised above heart level, if possible, to reduce swelling
• Use a cold compress or a clean cloth soaked in cool water for 20 minutes at a time to soothe pain
• Drink plenty of fluids and rest
• Moisturise the skin once the infection is clear to prevent cracks
• Wash your hands well and keep any cuts clean and covered

Medical treatments

Antibiotics are the main treatment. You might take them by mouth or, if the infection is severe, through a drip at the hospital. Your doctor may also advise medicines to ease pain and fever. For people with repeated episodes, a long-term antibiotic plan may be discussed. Always take any medicines exactly as your healthcare team recommends.

When is surgery considered?

Surgery is rarely needed, but if the infection creates a pocket of pus (an abscess), a healthcare professional may need to drain it. If dead tissue forms, a surgeon might need to remove it. These situations are uncommon.

Living with this condition

After a cellulitis flare-up, look after the affected skin carefully. Keep it clean, dry, and moisturised. If you have swelling, keep the limb raised when resting and speak to your healthcare team about compression stockings or other support.

Lifestyle tips

• Wear protective footwear if you have poor circulation or nerve damage
• Trim your nails carefully to avoid accidental cuts
• Treat athlete's foot or eczema promptly
• Use sunscreen and insect repellent to prevent sunburn and bites
• Avoid going barefoot outside

Diet and exercise

Eating a balanced diet and staying active can support your immune system and circulation. Gentle movement, such as walking, can improve blood flow, but rest during the acute phase until the infection improves.

Mental health and emotional wellbeing

Repeated cellulitis can be worrying and frustrating. It may make you anxious about your body or tired of hospital visits. It's normal to feel this way. Talk to your healthcare team about your concerns, and seek support from friends, family, or a counsellor if you need a listening ear.

Prevention

You can lower your risk by protecting your skin from breaks, keeping existing conditions like athlete's foot or eczema under control, and managing any swelling in your limbs. If you've had cellulitis more than once, your doctor may discuss long-term antibiotics as a preventive measure.

Vaccines

There is no specific vaccine for cellulitis. Keeping up to date with routine vaccines can help prevent infections that could weaken your skin or immune system.

Screening programmes

There is no routine screening for cellulitis, but regular skin checks by your doctor can be helpful if you have had recurrent episodes or have risk factors like diabetes or poor circulation.

Complications

If left untreated

• The infection can spread into the bloodstream (sepsis), which is life-threatening
• The affected area may develop deep abscesses or tissue death
• Long-term swelling of the limb (lymphoedema) may become worse
• The breakdown of skin can become a chronic wound or ulcer

Long-term outlook

Most people make a full recovery within 7 to 10 days of starting antibiotics, even though the skin may take longer to return to normal. If you have had one episode, your risk of another is higher, but many people never have a second one. With careful skin care and follow-up, you can manage flare-ups and keep living an active life.

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