cellulitis that comes and goes

Overview

Cellulitis is a common bacterial infection of the deeper layers of the skin. It causes the skin to become red, swollen, warm, and tender. When it comes and goes, it means the infection has happened more than once, often in the same area of the body.

Repeated episodes are fairly common. Around 1 in 5 people who have cellulitis once will get it again.

Anyone can get cellulitis, but it is more likely in people with diabetes, poor circulation, a weakened immune system, or long-term swelling in the arms or legs (called lymphedema).

Symptoms

Common symptoms

• Redness and swelling that spreads quickly
• Warmth or heat in the affected area
• Pain or tenderness
• Tight, shiny skin
• Fever, chills, or feeling unwell

Symptoms in children

• Redness, swelling, or warmth on the skin
• Fussiness, low energy, or loss of appetite
• Fever or chills

Symptoms in older adults

• Symptoms may be less obvious at first
• Confusion or unusual sleepiness
• A sudden increase in swelling or redness
• Pain that worsens or a feeling of being unwell

Causes

Main causes

• Bacteria entering through a break in the skin, such as a cut, insect bite, or ulcer
• Skin conditions like athlete's foot, eczema, or psoriasis that create tiny cracks
• Surgical wounds or skin injuries

Risk factors

• Previous cellulitis in the same area
• Chronic swelling (lymphedema) in a limb
• Obesity
• Diabetes
• Poor circulation or vein problems
• A weakened immune system from medication or illness
• Repeated skin injuries from sports, nails, or other trauma

When to see a doctor

See a doctor urgently if:

• If the redness or swelling is spreading rapidly
• If you have a fever or feel very unwell
• If you have a chronic condition like diabetes or heart failure

Book a routine appointment if:

• If you see any red, warm, or swollen patch of skin that does not improve after 24 to 48 hours
• If you have repeated episodes of cellulitis and want to discuss prevention

Diagnosis

Your doctor will look at the affected skin and ask about your symptoms, recent injuries, and health history. They will often check for fever and other signs of infection.

Tests that may be done

• Usually no tests are needed for mild cases
• A swab or blood test may be taken if there is fluid or the infection is severe
• Sometimes an ultrasound or other imaging is used to look for a deeper infection

What to expect at your appointment

Most people are diagnosed during a physical exam. The doctor may mark the edge of the redness with a pen to see if it spreads.

Treatment

Cellulitis is treated with antibiotics to kill the bacteria. If you have repeated episodes, your doctor will also look for and treat the cause, such as a skin crack or swelling in the limb.

Self-care at home

• Rest the affected limb and raise it above heart level when possible
• Keep the skin clean and dry, and wash any breaks with mild soap and water
• Use a moisturiser to keep skin supple and prevent cracking
• Do not scratch itchy skin — ask for advice if you have eczema or athlete's foot

Medical treatments

Your doctor will usually prescribe an antibiotic course taken by mouth. It is important to finish the full course, even if you feel better. For severe cases, antibiotics may be given through a drip in hospital. If the infection keeps coming back, your doctor may recommend a longer or different course, or treat an underlying condition like oedema or a fungal infection.

When is surgery considered?

Surgery is not usually needed. Rarely, if a pocket of pus (abscess) forms, a doctor may drain it.

Living with this condition

Once you've had cellulitis, take good care of your skin to prevent repeat infections. Check your legs and feet daily for cuts, cracks, or redness, especially if you have diabetes or poor circulation.

Lifestyle tips

• Trim toenails carefully and avoid cutting the skin
• Wear protective footwear outdoors
• If you have athlete's foot, treat it promptly to prevent cracks between your toes
• If you have a swollen limb, keep it moisturized and consider compression stockings if recommended by your doctor

Diet and exercise

A balanced diet, regular physical activity, and maintaining a healthy weight help your immune system and circulation. But be careful to protect your skin during exercise to avoid injuries.

Mental health and emotional wellbeing

Repeat infections can be frustrating and stressful. It is normal to worry about the next episode. Talk to your doctor about these feelings, and remember that treatment is improving all the time.

Prevention

Often, yes. You can lower your risk by protecting your skin, treating any skin breaks quickly, and managing conditions like diabetes, lymphedema, or obesity.

Complications

If left untreated

• The infection can spread deeper into tissues, causing an abscess
• It can enter the bloodstream and cause a life-threatening condition called sepsis
• It may cause permanent damage to the lymphatic system, leading to more swelling and more infections

Long-term outlook

With prompt treatment, most people recover fully. If you have repeat episodes, working with your doctor to manage risk factors can reduce them and help you stay healthy.

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