How to treat cellulitis?

Written by: Ayesha Khan, MBBS

In a Nutshell

• Cellulitis refers to bacterial infection of skin that is marked by red, hot, inflamed, and painful skin
• Cellulitis can become life threatening if not treated promptly
• Treatment regimen involves administration of oral/ intravenous antibiotics and supportive care. Surgery may be needed for abscess.

What is Cellulitis?

Cellulitis is a serious often life-threatening bacterial infection that affects skin and soft tissues underneath the skin. It occurs when bacteria enter the skin and causes widespread inflammation. Cellulitis presents with warm, tender, inflamed, red and painful skin.

Most common sites of occurrence of cellulitis are hands, lower legs, and feet, however, it can occur on other part of body as well as face. Cellulitis is usually limited to the superficial layers of skin but sometimes in severe cases infection may spread to the deeper layers of skin as well as, lymph nodes and bloodstream, in which case it may lead to septic shock or even death.

If you are suspecting cellulitis, seek medical advice as early as possible.

Evidence-Based Treatment Regimen

Although cellulitis can only be treated with antibiotics otherwise it may spread to bloodstream and becomes life threatening. However, to reduce your pain and discomfort and to speed up your recovery, you can also follow some home remedies along with antibiotics.

• Take OTC pain killers such as ibuprofen and paracetamol as needed
• It is ideal to take optimal rest until your condition improves
• To reduce swelling, elevate the affected limb or tissue with pillows while sitting or lying
• Hydrate yourself by drinking enough fluids. Healthcare providers suggests 8-10 cups of water are generally sufficient per day. A great indicator of hydration is that your urine should be clear
• You can use cold compresses over the affected tissue every 4-6 hours for soothing relief
• Avoid wearing compression stockings till your condition improves
• Maintain optimal hygiene
• Moisturize your skin on regular basis
• Wear protective clothing if you are going outdoors

Antibiotics for moderate to severe cellulitis

- Cellulitis can be managed by taking antibiotics orally from 7 to 14 days. The dosage and type of antibiotic regimen varies, according to the type of bacteria and severity of infection.

- For pain management, your doctor may prescribe pain killers such as paracetamol and ibuprofen.

Cellulitis can go away within 7 to 10 days after starting antibiotic course however, in case of severe infection and weak immunity, treatment can be extended. Make sure to complete your antibiotic course even if you have started feeling better within days of starting the therapy to ensure complete healing and recovery. Low dose antibiotics for long term use may also be prescribed by some doctors to avoid reoccurrence of infection.

You may need intravenous antibiotics if:

• You have developed high grade fever
• Infection is not responding to current antibiotics.
• You have weak immunity.
• You have low blood pressure

Surgical Intervention

Usually antibiotics treat the infection completely however, in severe cases if you develop abscess then surgery is required to clear and drain the pus and dead tissue.

To perform surgery, your doctor will numb the affected area and apply a small incision on the abscess to drain the pus and dead tissue (also known as debridement). Once wound debridement is done, a dressing is applied to ensure optimal healing.

Nuances/ Safety

Contact your doctor if you notice:

- No improvement in your condition within 3 days of taking antibiotics.

- Symptoms are getting worse after starting the treatment.

- You have developed fever, shivering, blood pressure changes, or other signs of systemic infection as it could be due to necrotizing fasciitis (a serious complication of cellulitis)

- If you have developed painful, swollen glands

- If you have compromised immune system (diabetes, history of chemotherapy)

Strength of Evidence: B
The recommendations made in this article are tested and approved by clinicians and investigators after conducting clinical trials and evaluating clinical cases of cellulitis.

Our Ruling

Cellulitis is a serious life-threatening skin infection that is caused by bacterial colonization of the deeper layers of skin. Treatment is generally by antibiotics that are carefully prescribed after identifying the source and severity of infection. In severe cases, surgical intervention is needed to drain abscesses.

Our Sources:

1. NHS - Cellulitis
2. American Academy of Dermatology - Cellulitis treatment