Introduction:

Cellulitis is a bacterial infection of the skin. It can also affect the deeper layers of connective tissue beneath your skin and, in severe cases, spread to your lymph nodes. Bacteria get into the skin through a cut, scrape, or other laceration. Cellulitis most often affects the legs, but it may also affect the arms, face, and scalp. Generally, taking antibiotics cures cellulitis. However, the condition sometimes leads to serious complications. Without treatment, it can become life threatening.

Signs and Symptoms:

• Pain and tenderness
• Edema (swelling caused by fluid in the tissues)
• Redness of the skin
• Skin that is warm to the touch
• Fever
• Chills

What Causes It?:

Cellulitis is caused by bacteria, most often streptococcus or Staphylococcus aureus, that get into the body through a break in the skin. In 50 - 60% of cases, there is some kind of skin injury (for example, cuts, insect bites, burns, surgical incisions, intravenous catheters, dermatitis). Methicillin-resistant staphylococcus aureua (MRSA) infection is a more serious type of staph infection and is on the rise. In the case of erysipelas, a type of cellulitis involving the lymph system, about one-third of cases are preceded by an upper respiratory infections. It is seen in infants, young children, and the elderly, and is generally caused by streptococcal infection.

Who's Most At Risk?:

You are at risk for developing cellulitis if you have the following:

• Older age -- as your circulation grows weaker with age, it' s easier for skin abrasions to become infected
• Diabetes
• Chickenpox and shingles
• Lymphedema (swelling of arms or legs) -- swollen arms and legs may cause skin to crack
• Fungal infections of the feet -- can also cause cracks in the skin
• Contaminated wounds
• A weakened immune system
• A general infection

What to Expect at Your Provider's Office:

If you have symptoms of cellulitis, you should see your doctor right away. If you have a fever with a rash, go to the emergency room. Your health care provider will do a thorough physical examination to see what is causing the condition and which antibiotic therapy to prescribe. Blood tests and imaging may also be used.

Treatment Options:

Prevention

To help prevent cellulitis, follow these steps:

If you have a cut or scrape, wash the area gently with soap and water. Apply an antibiotic cream or ointment, and cover the area with a bandage. Change the bandage every day and watch for signs of infection.

If you have diabetes or circulatory problems, check your hands and feet daily for scrapes or cuts, or a fungus such as athlete' s foot. Keep your skin moisturized and don' t go barefoot.

Treatment Plan

Cellulitis is treated with antibiotics. To help ease pain, raise the affected arms or legs, keep still, and apply cool, wet, sterile bandages. If your symptoms aren't better after a few days, you may need hospitalization so doctors can give you antibiotics intravenously (IV).

Drug Therapies

Your health care provider will prescribe antibiotics for your infection as well as pain relievers if needed. Your doctor may prescribe an antibiotic that works against both staph and strep, such as cephalexin (Keflex). It is important to take the entire course of antibiotics, even if your symptoms go away before you finish.

Surgical and Other Procedures

If antibiotics don' t work, you may need surgery to drain any underlying abscess (infected tissue).

Complementary and Alternative Therapies

It is important to get conventional medical treatment for cellulitis. It can spread rapidly, so you should start antibiotics as soon as possible to prevent complications. Most alternative therapies have not yet been studied for use specifically in cellulitis. Some may reduce the risk of getting cellulitis or ease some of the symptoms when used along with conventional care. You should never treat cellulitis with alternative therapies alone. It is important to tell your doctor if you are taking any herbs or supplements because some may interfere with antibiotic therapy.

Nutrition

The following supplements may strengthen the immune system and help skin heal:

• Vitamin C (1,000 mg two to six times per day in adults for short periods)
• Vitamin E (400 - 800 IU per day)
• Zinc (30 mg per day)
• Bromelain (250 mg two to three times per day), taken between meals, reduces inflammation. It is often used with turmeric (Curcuma longa), an anti-inflammatory that makes the effects of bromelain stronger. Bromelain and turmeric can increase the risk of bleeding. If you take blood-thinning medications such as warfarin (Coumadin) or aspirin, do not take bromelain and turmeric without asking your doctor.
• Probiotic supplement (containing Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) a day, for gastrointestinal and immune health. Taking antibiotics can upset the balance between good and bad bacteria in your gut and cause diarrhea. Taking probiotics, or “friendly” bacteria, helps restore the right balance.

Researchers have not studied the ways specific nutrients may affect cellulitis. However, flavonoids -- compounds in such fruits as citrus, blueberries, grapes; in vegetables, including onions; and in tea and red wine -- seem to help reduce lymphedema and the risk of cellulitis. Quercetin (up to 1,000 mg two or three times per day) is a flavonoid available as a supplement.

Applied to the skin, honey may help wounds heal faster and keep infection at bay. Several studies show that honey, applied as a dressing after surgery, helps incisions heal without complications. Don' t apply honey to an open wound, and talk to your doctor before using honey for any cuts or scrapes.

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, under the supervision of your health care provider. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

There are no scientific studies showing that herbs have a direct effect on cellulitis, but the following herbs may help strengthen the immune system and kill bacteria on the skin. Never apply herbal preparations to an open wound without asking your doctor first. Be sure to tell your doctor about any herbs you use, because some can interfere with conventional treatment.

Taken by mouth:

• Echinacea (Echinacea spp., 500 - 1,000 mg three times per day) is used to strengthen the immune system. It may also be used topically as a gel or cream containing 15% juice of the herb to treat inflammatory skin conditions.
• Pycnogenol (Pinus pinaster, 200 mg per day), an extract of the bark of a particular type of pine tree, helps promote skin health.
• Thyme (Thymus vulgaris, 1 - 2 g per day in divided doses). Thyme may have antibacterial and antifungal properties, although there' s no evidence that it helps treat cellulitis specifically. Thyme can increase the risk of bleeding. Ask your doctor before taking thyme if you take blood-thinning medications such as warfarin (Coumadin) or aspirin, and never take oil of thyme, which can be toxic.
• Gotu kola (Centella asiatica, 60 mg two times per day). In a few studies, gotu kola seems to help wounds heal and reduce risk of infection. Gotu kola interacts with a number of medications, so be sure to ask your doctor before taking it. Do not take gotu kola if you experience anxiety or have high blood pressure.

Applied to the skin:

• Yarrow (Achillea millefolium) is approved in Great Britain for skin infections and inflammation. It is applied topically. Use 100 g per 5 gallons of warm or hot water for a sitz bath.
• Goldenseal root (Hydrastis canadensis), which has anti-inflammatory and antibacterial properties, and slippery elm (Ulmus fulva), an antiseptic, may be made into a paste and placed on the affected area two times per day.
• Calendula flower (Calendula officinalis) is approved in Germany for topical application to leg ulcers, open wounds that can readily become infected. Make a tea by adding one to two teaspoons dried flowers to one cup boiling water and steeping for 5 - 10 minutes. Let cool, then soak a sterile, soft cloth with the solution and apply to affected area.
• Tea tree oil (Melaleuca alternifolia) has antibacterial and antifungal properties. Some studies suggest tea tree oil may help fight athlete' s foot and keep minor cuts and scrapes from becoming infected.
• Fenugreek seed (Trigonella foenum-graecum), which contains flavonoids, is approved in Germany for external use on skin inflammation and infections. Mix 50 g of powdered fenugreek seed with one quart of hot water and let stand until it forms a thick paste. Apply to a sterile, soft cloth and place on the affected area.

Homeopathy

Although very few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths would recommend the following remedies for the treatment of cellulitis based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

• Apis Mellifica -- for swelling with a puffy appearance that worsens with heat and pressure, especially in the afternoon and is better with cold applications, open air, movement, and sitting upright
• Cantharis -- for restless and anxious individuals. It may be used for children. Cahtaris is only available under the direction of a licensed homeopath.
• Lachesis -- for symptoms that tend to be worse on the left side of the body and during and immediately after sleep
• Mercurius -- for people who are bothered by both heat and cold, and are often trembling and impulsive
• Rhus toxicodendron -- for people who are restless and anxious with itching that tends to worsen at night but is relieved by warm compresses or pressure
• Sulphur -- for hot, burning skin with itching that worsens at night and with washing

Seek immediate medical attention if fever and swelling do not subside after 24 hours.

Acupuncture

Acupuncture other Traditional Chinese Medicine practices may help with the underlying cause of cellulitis and may strengthen the immune system. However, no scientific studies have been done to see if they work specifically for cellulitis. The practitioner should be very careful when piercing skin that may be infected, because there is a risk of spreading the infection further. Talk to your doctor first and use a qualified acupuncturist with experience in treating infectious skin disease.

Massage

Do not use massage if you have an active infection. However, massage that promotes lymph drainage, when used with compression and exercise, may help prevent cellulitis.

Prognosis and Possible Complications:

Antibiotics usually cure cellulitis. While complications are rare, they can be serious and even life threatening if the infection spreads to the blood. Complications are more common in very young children, the elderly, or in people who have immune system disorders. Possible complications include abscesses, gangrene (tissue destruction), and thrombophlebitis (inflammation of superficial veins). Some people are prone to recurrence of cellulitis, often in the same area, leading to permanent skin changes. Gangrene may result in loss of a limb.

Following Up:

Your health care provider should see you periodically to make sure you have no complications.

Alternative Names:

Skin infection