Cellulitis in adults

Overview

Cellulitis is a bacterial infection of the deeper layers of the skin. It causes the affected area to become red, swollen, warm, and painful. The infection usually starts when bacteria enter the skin through a cut, scrape, or other break. If not treated quickly, it can spread and become serious.

Yes, cellulitis is a common skin infection that sends many people to the doctor each year. It can happen at any age, but is more common in adults over 50.

Anyone can get cellulitis, but it is more likely if you have a break in your skin, such as from an injury, insect bite, or surgical wound. People with diabetes, obesity, poor circulation, lymphedema (swelling from fluid buildup), or a weak immune system are at higher risk.

Symptoms

Common symptoms

• Redness that spreads quickly on the skin
• Swelling in the affected area
• Pain or tenderness when touched
• The skin feels warm or hot to the touch
• A shiny, tight appearance of the skin
• A small blister or area of weeping fluid

Symptoms in children

• Children may have the same redness and swelling as adults, but the infection can appear on the face or around the eyes (periorbital cellulitis).
• They may be fussy, have a fever, or not want to move the affected area.

Symptoms in older adults

• Older adults may not have obvious redness or pain, especially if they have nerve damage or poor circulation.
• Instead, they might experience confusion, a general feeling of being unwell, or a rapid decline in mobility.
• The skin may appear pale or cool rather than red and warm.

Causes

Main causes

• Bacteria, most often Streptococcus (strep) or Staphylococcus (staph), enter the skin through a break.
• Common breaks include cuts, scratches, insect bites, surgical wounds, or areas where the skin is dry and cracked.
• Less commonly, bacteria can enter through a skin condition like athlete's foot or eczema.

Risk factors

• Having a skin injury or chronic skin condition
• Being overweight or obese
• Having diabetes, especially if poorly controlled
• Having a weakened immune system (from medications or illness)
• Poor circulation in the legs (for example, from varicose veins or lymphedema)
• Previous cellulitis in the same area
• Using intravenous (IV) drugs

When to see a doctor

See a doctor urgently if:

• If you have a fever, chills, or feel very unwell with a red, swollen area of skin.
• If the redness is spreading quickly, especially over a period of hours.
• If you have a condition that weakens your immune system (like diabetes or chemotherapy).
• If the affected area is on your face or near your eyes.

Book a routine appointment if:

• If you have a red, swollen area that is warm and painful but you have no fever and feel otherwise well.
• If the redness is not spreading rapidly and you have no known high-risk conditions.
• You should still see a doctor within 24 to 48 hours, or as soon as possible.

Diagnosis

A doctor will diagnose cellulitis by examining your skin and asking about your symptoms and medical history. They will look for signs of infection like redness, swelling, and warmth. They might gently press on the area to check for pain or fluid.

Tests that may be done

• Usually no tests are needed – the diagnosis is based on the look and feel of your skin.
• Sometimes the doctor may take a small sample of fluid from a blister or wound to send to a lab and find out which bacteria is causing the infection.
• A blood test may be done if the infection seems severe or if you have a high fever.

What to expect at your appointment

The visit is quick. The doctor will ask when symptoms started, if you have any other health conditions, and if you have had any recent injuries. They may mark the edge of the redness with a pen to see if it spreads. They will then prescribe an antibiotic (usually a pill) and tell you how to take care of the area at home.

Treatment

Cellulitis is treated with antibiotics, usually taken by mouth, for about 7 to 10 days. It is important to finish all the medicine, even if you feel better. The infection often starts to improve within 24 to 48 hours. In severe cases, you may need to go to the hospital for IV antibiotics.

Self-care at home

• Rest the affected limb or area and keep it raised (elevated) to reduce swelling.
• Gently clean the area with mild soap and water, and keep it covered with a clean, dry bandage.
• Do not pop blisters or put ointments on the skin unless your doctor says it is okay.
• Take over-the-counter pain relievers (like paracetamol or ibuprofen) if you have pain or fever – but check with a pharmacist or doctor first.
• Drink plenty of fluids and eat well to help your body fight the infection.

Medical treatments

Doctors prescribe antibiotics that kill the bacteria causing cellulitis. The type depends on the likely bacteria, your health history, and any allergies. You will take them by mouth for about a week, but the exact length depends on how you respond. For severe infections or if you cannot take oral medicine, you may be treated in the hospital with antibiotics through a vein (intravenous). Your doctor will tell you which medicine is best for you.

When is surgery considered?

Surgery is rarely needed for cellulitis. If a pocket of pus (abscess) forms inside the infected area, a doctor may need to drain it. Very severe cases with dead tissue (necrotizing fasciitis) require urgent surgery, but this is extremely rare.

Living with this condition

While you recover, you may need to rest the affected area and keep it elevated. You can usually continue normal activities if you feel up to it, but avoid using the area too much until swelling and pain decrease. Keep an eye on the redness and see your doctor if it grows or you get a fever.

Lifestyle tips

• Keep your skin clean and moisturised to prevent cracks.
• Treat any cuts or scrapes immediately by washing and covering them.
• If you have athlete’s foot or eczema, treat it promptly to avoid breaking the skin.
• Check your feet and legs every day if you have diabetes or poor circulation.

Diet and exercise

A healthy diet rich in fruits, vegetables, and protein can help your immune system fight infection. While you are unwell, it is fine to rest more than usual. Once you feel better, gentle movement, like walking, can improve circulation and help prevent future episodes.

Mental health and emotional wellbeing

Having cellulitis can be worrying, especially if it is severe or keeps coming back. It is normal to feel anxious or frustrated. Talk to your doctor about your concerns. Most people make a full recovery with treatment.

Prevention

You cannot always prevent cellulitis, but you can lower your risk by taking good care of your skin. Clean any cuts, scrapes, or bites with soap and water, and cover them with a clean bandage until they heal. Keep your skin moist to avoid cracking, and treat underlying conditions like athlete’s foot or eczema. If you have lymphedema or poor circulation, talk to your doctor about ways to reduce the risk of infection.

Vaccines

There are no vaccines specifically for cellulitis. However, staying up to date on vaccines that prevent infections (like the flu vaccine or pneumococcal vaccine) can help keep your immune system strong.

Screening programmes

There is no routine screening for cellulitis. If you have a high risk condition, your doctor may check your skin during regular visits.

Complications

If left untreated

• The infection can spread to deeper tissues, causing an abscess (a pocket of pus).
• It can travel through the bloodstream to other parts of the body (sepsis – a life-threatening condition).
• Damage to the lymph vessels (lymphangitis) can cause long-term swelling.
• Rarely, the infection can destroy skin tissue (necrotizing fasciitis), requiring urgent surgery.

Long-term outlook

With prompt antibiotic treatment, almost all cases of cellulitis heal completely within a week or two. Even severe cases have a very good outlook if treated in hospital. Some people may get cellulitis again, but your doctor can help you take steps to prevent it. The key is to see a doctor as soon as you notice symptoms – do not delay.

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