long lasting cellulitis

Overview

Cellulitis is a bacterial skin infection that makes the skin red, swollen, hot, and painful. Long-lasting cellulitis means the infection takes a long time to clear up or keeps coming back again and again, even after treatment.

Cellulitis is a fairly common skin infection. Long-lasting or recurrent cellulitis is less common, but it can happen in people with certain risk factors.

Anyone can get cellulitis, but long-lasting cellulitis is more likely in people with lymphatic damage or swelling (lymphoedema), a weakened immune system, diabetes, or repeated breaks in the skin. It can also affect people who have had cellulitis before.

Symptoms

Common symptoms

• Redness and swelling on the skin
• Warmth and tenderness to touch
• Pain in the affected area
• Fever or chills
• Blisters or dimpling of the skin

Symptoms in children

• Children may have the same skin symptoms as adults
• They may also be unusually sleepy, fussy, or have a high fever
• Sometimes the infected area is on the face or around the bottom

Symptoms in older adults

• Older adults may experience confusion or a sudden change in behaviour
• The infection can spread more quickly and cause more severe symptoms
• They are at higher risk for complications, such as sepsis

Causes

Main causes

• Bacteria (usually streptococcus or staphylococcus) entering through a break in the skin, such as a cut, ulcer, or scratch
• Cracks between the toes caused by athlete’s foot
• Surgical wounds, insect bites, or punctures that become infected

Risk factors

• Lymphoedema (chronic swelling of a limb)
• Previous episodes of cellulitis
• Diabetes, especially if blood sugar levels are not well controlled
• Obesity
• Weakened immune system from medication or illness
• Skin conditions like eczema or psoriasis that cause cracks and breaks

When to see a doctor

See a doctor urgently if:

• If you have symptoms of cellulitis that are spreading or getting worse
• If you have cellulitis along with a fever, chills, or rapid swelling
• If you have diabetes or a weakened immune system and develop any skin infection

Book a routine appointment if:

• If you have had cellulitis more than once in the same area
• If your skin infection does not fully heal after completing a course of antibiotics
• If you have ongoing swelling in a limb that makes you prone to repeated infections

Diagnosis

A doctor or nurse will usually diagnose cellulitis by looking at the skin and asking about your symptoms and medical history. In most cases, no tests are needed to confirm it.

Tests that may be done

• Blood tests to check for signs of infection or inflammation
• A swab or culture from any wound or discharge to identify the bacteria
• Imaging tests, such as an ultrasound, if the doctor suspects an abscess or deeper infection

What to expect at your appointment

During your appointment, the doctor will examine the affected area and may mark the edges of the redness. They will check your temperature and look for any other signs of infection. If cellulitis is diagnosed, you will likely be prescribed a course of antibiotics and advised to keep the area clean and elevated. If your infection is severe or keeps coming back, you may be referred to a specialist.

Treatment

Treatment for long-lasting cellulitis usually involves antibiotics to clear the infection and also addressing any underlying issues that make the infection keep coming back. Depending on how severe the infection is, treatment can be given at home or in the hospital.

Self-care at home

• Elevate the affected limb (if the infection is on an arm or leg) to reduce swelling
• Keep the skin clean and dry
• Use moisturisers to prevent cracks in the skin
• Take prescribed antibiotics exactly as directed and complete the full course

Medical treatments

Antibiotics are the main treatment for cellulitis. They may be given as tablets or, in more serious cases, through a drip in the hospital. For long-lasting or recurrent cellulitis, your doctor may recommend a longer course of treatment, repeated courses, or a low-dose antibiotic to prevent future episodes. Treatment for underlying conditions, such as lymphoedema or diabetes, may also be needed to reduce the risk of another infection.

When is surgery considered?

Surgery is sometimes needed if the infection has caused an abscess (a collection of pus) that needs draining, or if there is dead skin tissue that must be removed. This is not common, but your care team will discuss it if it becomes necessary.

Living with this condition

Living with long-lasting cellulitis means being careful with your skin and watching for early signs of infection. Check your legs and feet daily for cuts, blisters, or swelling. Treat any fungal infections like athlete's foot quickly, and keep your nails trimmed to avoid accidental scratches.

Lifestyle tips

• If you have lymphoedema, use compression stockings or bandages as recommended by your healthcare team
• Protect your skin with insect repellent and appropriate clothing outdoors
• Maintain a healthy weight to improve circulation and reduce pressure on your limbs
• Avoid walking barefoot, especially outdoors, to prevent cuts and punctures

Diet and exercise

A balanced diet rich in fruits, vegetables, and lean proteins can help keep your immune system strong. Gentle exercise, such as walking or leg lifts, can improve circulation and prevent swelling. Always speak to your doctor before starting a new exercise routine, especially if you have lymphoedema.

Mental health and emotional wellbeing

Dealing with a long-lasting infection can be frustrating and stressful. You may feel anxious about the infection returning, especially if you have had severe episodes before. These feelings are normal and it is important to talk about them with your healthcare team or someone you trust.

Prevention

Yes, there are steps you can take to greatly reduce your chances of getting cellulitis again. Keeping your skin healthy, treating any cracks or fungal infections quickly, and managing underlying conditions like diabetes or lymphoedema are all important parts of prevention.

Vaccines

There is no vaccine that specifically prevents cellulitis, but keeping your routine vaccinations up to date, including tetanus, can help prevent certain infections that can enter through breakages in the skin.

Screening programmes

Regular check-ups with your doctor may be helpful if you have diabetes or lymphoedema, as these conditions increase your risk of recurrent cellulitis. Your doctor can monitor your skin and provide early treatment for any issues.

Complications

If left untreated

• The infection can spread deeper into the tissue, forming an abscess
• Bacteria can enter the bloodstream, causing sepsis, which is life-threatening
• Long-term swelling and damage to the lymphatic system
• Recurrent episodes can lead to chronic skin changes, such as thickening or hardening

Long-term outlook

With the right treatment and management, most people with long-lasting cellulitis recover well. It may take time and patience, but you can reduce the risk of future episodes and live a full, active life. Your healthcare team is there to support you every step of the way.

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