cellulitis treatment options overview

Overview

Cellulitis is a common bacterial skin infection that happens when bacteria get into the deeper layers of your skin through a cut, crack, or other break in the skin. It usually affects the lower legs, but can appear anywhere. The skin becomes red, swollen, warm, and tender.

Cellulitis is quite common. In the UK, it is one of the most frequent reasons people visit their GP or are admitted to hospital for skin infections.

Anyone can get cellulitis, but it is more common in adults over 45, people with diabetes, those with a weakened immune system, and people with circulation problems or lymphoedema (swelling due to fluid build-up).

Symptoms

Common symptoms

• Red, swollen, hot area of skin that grows larger
• Skin that feels tender or painful
• Tight, glossy skin
• Fever or chills
• If there is a wound, it may have a yellow crust or pus

Symptoms in children

• Sudden redness and swelling that spreads
• Fever, irritability, or sleepiness
• Pain or tenderness when the area is touched
• Sometimes blisters or boils

Symptoms in older adults

• Less obvious redness, which can be harder to see on darker skin
• Confusion or feeling suddenly unwell
• Rapidly spreading swelling or a red line
• Fever or low body temperature

Causes

Main causes

• Most often caused by bacteria called Streptococcus or Staphylococcus entering through a break in the skin
• Breaks can come from cuts, scrapes, insect bites, ulcers, athlete's foot, or skin conditions like eczema
• In rare cases, bacteria can enter through healthy skin if the person has a severely weakened immune system

Risk factors

• Skin breaks or wounds
• Poor circulation or varicose veins
• Lymphoedema (chronic swelling of an arm or leg)
• Diabetes
• Weakened immune system due to illness or medication
• Obesity
• Previous episodes of cellulitis

When to see a doctor

See a doctor urgently if:

• If the red area is growing rapidly
• If you have a fever, chills, or feel generally unwell
• If you have diabetes or a weak immune system and notice any skin infection
• If you see a red line moving away from the infected area

Book a routine appointment if:

• If you have any persistent area of redness, swelling, or pain in the skin
• If an existing wound is not healing or starts to look worse
• If you have had cellulitis before and want to talk about preventing it again

Diagnosis

A doctor will usually diagnose cellulitis by looking at your skin and asking about your symptoms. They may mark the edge of the redness with a pen to see if it spreads.

Tests that may be done

• Sometimes a blood test to check for infection
• If there is pus or a wound, a small swab may be sent to a lab
• If the diagnosis is unclear, they might do a skin ultrasound or refer you to a skin specialist

What to expect at your appointment

At your appointment, the doctor will examine the area, check your temperature and possibly your blood pressure. They may ask about any recent skin injuries or other medical conditions. You will usually be asked to start treatment quickly.

Treatment

Treatment usually involves antibiotics, either as tablets or, for more severe cases, intravenous (into a vein) antibiotics in hospital. You can also do a lot at home to help yourself feel better.

Self-care at home

• Keep the affected area raised above the level of your heart to reduce swelling
• Rest and drink plenty of fluids
• Take simple pain relief for discomfort if needed – always ask your pharmacist or doctor first to make sure it is safe for you
• Keep the skin clean and dry, but do not rub it
• Finish the full course of antibiotics exactly as prescribed, even if you feel better
• Watch the area for signs of improvement or worsening

Medical treatments

Antibiotics are the main treatment for cellulitis. The choice of antibiotic and whether you take it by mouth or through a drip depends on how severe the infection is, where it is on your body, and your overall health. Doctors usually start with an antibiotic that covers the most common bacteria. You may be given a prescription to take home, and sometimes a follow-up appointment to check the infection is clearing. For severe cellulitis, or if you are unable to take tablets, you may need intravenous antibiotics in hospital for a few days. If there is an underlying wound or fungal infection, treating that is also important.

When is surgery considered?

Surgery is rarely needed, but it may be necessary if an abscess (a pocket of pus) forms, or if the infection causes tissue death. In these cases, a surgeon would drain the abscess or remove dead tissue. This is uncommon with prompt treatment.

Living with this condition

Most people feel much better within 48 hours of starting antibiotics, but the skin may take a few weeks to fully return to normal. You may notice the red area fades and the swelling goes down. It is important to finish your medication and follow your doctor's advice. Keep the area clean and dry, and avoid tight clothing or shoes.

Lifestyle tips

• Moisturise your skin to avoid cracks and dryness
• Wear protective footwear when walking outside, especially if you have diabetes or poor circulation
• Treat any athlete's foot or fungal infections between the toes promptly
• If you have lymphoedema, keep using your compression garments as advised

Diet and exercise

A balanced diet rich in fruits, vegetables, and protein can support your immune system and help with healing. Gentle movement, like walking or leg lifts, can improve circulation, but avoid strenuous exercise while you are unwell. Always raise the affected limb when resting.

Mental health and emotional wellbeing

Having cellulitis can be worrying, especially if it is painful or keeps coming back. It is normal to feel anxious or frustrated. If you feel low or bothered by repeated infections, talk to your doctor or nurse. They can offer support and, if needed, refer you for counselling.

Prevention

You can lower your chances of getting cellulitis by looking after your skin and treating any breaks or infections quickly. Keeping your skin moist, cleaning cuts well, and using an antiseptic cream on minor wounds can help. If you have diabetes, good blood sugar control is important.

Vaccines

There is no vaccine specifically for cellulitis, but staying up to date with general vaccinations, such as the flu and pneumonia vaccines, can help prevent infections that may lead to cellulitis in some people.

Screening programmes

There is no routine screening for cellulitis. However, if you have had cellulitis in the same area more than once, your doctor may suggest a review of your circulation or skin condition to help prevent future episodes.

Complications

If left untreated

• The infection can spread deeper into tissues, muscles, or bone
• Bacteria can enter the bloodstream, leading to sepsis, which is life-threatening
• You might develop an abscess that needs draining
• Repeated cellulitis can permanently damage the lymphatic system, causing long-term swelling (lymphoedema)

Long-term outlook

With early and proper treatment, most people recover completely from cellulitis within a week or two. Some people get it again, but you can take steps to reduce that risk. If you ever feel the infection is getting worse, seek medical help quickly. The key is starting treatment early, so you can usually expect a full recovery.

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