CELLULITIS. Information Leaflet. Your Health. Our Priority.

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1 CELLULITIS Information Leaflet Your Health. Our Priority.

2 Page 2 of 8 What is cellulitis? Cellulitis is a bacterial infection of the skin. It often affects the deep layers of the skin and sometimes the fat layer underneath the skin. Most people affected get cellulitis on their legs or arms, but sometimes it appears on the face, in the mouth, on the stomach or around the anus. Many cases of cellulitis are mild and can be treated effectively with antibiotics. (Cellulitis is a common infection of the skin. It usually affects the arms or legs) Is cellulitis contagious? Unless there is pus leaking from the infection, most forms of cellulitis are not contagious to other people. However if you have the infection, it is important to regularly wash your hands with soap and water and to avoid sharing common items such as towels and razors. Why do people get cellulitis? There are different types of bacteria that live normally on a person's skin. Most of the time these bacteria do not cause us any problems as the skin forms a very effective barrier against them. However, these germs may get through and cause an infection if a person gets a cut or break in their skin. Normally our own immune defenses are able to cope with these bacteria. Most people with cuts or breaks to the skin do not get these types of skin infections. However certain conditions can make a patient more likely to develop cellulitis. What increases my chances of getting cellulitis? Having a cut to your skin, even a very small one (e.g. from shaving, from an injection, or any other wound or abrasion that breaks the skin). Being overweight.

3 Page 3 of 8 Having a long-standing skin problem like eczema or psoriasis. The presence of other types of infections that may damage the skin, such as athlete's foot or chicken pox. Having a fluid buildup under the skin or in the body. This can happen due to poor circulation of blood, heart failure, or liver disease. Diabetes. A previous episode of cellulitis. What are the symptoms of cellulitis? The infected skin can become painful, red, warm and swollen. It often looks smooth and shiny. The infection can come on gradually or be quite sudden. Some patients can develop fevers or chills. Not all patients with cellulitis infection will have every one of the symptoms. Some patients only develop one or two, and some can present with none at all. (Common symptoms of cellulitis include painful, red, swollen and warm skin) How does cellulitis get diagnosed? If you develop any of the symptoms it is important that you visit your doctor. Diagnosis is usually made by a nurse or doctor after examining and looking at the skin. A simple swab can be taken in cases where: There is pus leaking from the infected area. The nurse or doctor is unsure of the diagnosis. The patient is not responding to the treatment as expected.

4 Page 4 of 8 How is cellulitis treated? As with any other infection, if you have cellulitis it is important to get treated by your doctor as soon as possible. If left untreated, there is a chance the infection can spread to the whole body and cause more serious problems. Cellulitis infection is treated with antibiotics, usually for about 7 to 10 days. The length of treatment and the type of antibiotic prescribed will depend on how serious the infection is and which type of bacteria is thought to be the most likely cause. If you are experiencing more severe symptoms, you may be treated in hospital with antibiotics that go into the vein. These are called IV antibiotics. As with any course of antibiotics it is important to continue to take the tablets even if you feel better before you finish them. Stopping early or skipping doses can allow the bacteria to develop antibiotic resistance and increase the length of time you need to be treated. It may also result in recurrent infections that are more difficult to treat. Is there anything else that can help my treatment? Yes. Raising the infected area causes gravity to drain inflammatory substances and any swelling that may be present. This is only possible if the site of your infection is the arm or leg. If so, you will be advised to raise your arm or leg (ideally above the level of your heart) 3 or 4 times a day for 30 minutes at a time. If the infection is in your leg you will have to do this lying down. Keep the area clean and dry. If you take a shower or bath, pat the area down with a clean towel. If you notice your skin becoming too dry you can use an emollient cream to prevent the skin from cracking. Ask your doctor or nurse which brands to use. Do not use topical antibiotics i.e. antibiotics that come in cream or liquid form that are meant to be rubbed in to the affected area. This is because their use can increase antibiotic resistance and cause allergic reactions in the patient. Make sure to look at your infection. If you notice any new changes such as ulcers, blisters, or leaking pus, contact your doctor or nurse. Soon after starting antibiotics some patients will notice that their infection looks redder. This is normal and is a sign that the antibiotics are working. However if the infected area grows larger, gets more swollen or more painful, see your doctor or nurse. The best way to tell if your infection in growing larger or getting worse is to take a

5 Page 5 of 8 photograph of the infected area. Then, using a pen, draw along the edges of your infection. If you do this you will be able to see very clearly if it grows larger. (Outlining the infected area of skin with a pen helps to see if the infection is getting larger) Finally, as well as treating your current infection, your doctor will review any underlying problems you may have. He or she will ensure you are receiving the best treatment for those conditions. This will help you to recover from your cellulitis infection and will reduce the risk of you getting cellulitis again. For example, it is important to remember in fungal infections such as athlete s foot to continue with your treatment up to two weeks after the infection has gone. This ensures that the fungus has cleared properly. When will I start to get better? Whilst symptoms may persist for several weeks, most patients begin to see some improvement within about 3 days. If your symptoms do not start to get better within that time, you should call your doctor or nurse. Will I get cellulitis again? Studies vary, but on average between 17% and 29% of patients with cellulitis will get the infection again. This means that patients who develop a cellulitis infection do not necessarily go on to get more cellulitis infections, but getting cellulitis once does make it more likely you will get it a second time. Rates of re-infection depend on:

6 Page 6 of 8 The presence of certain types of underlying illness the patient may have. How well these conditions are managed. The care the patient takes to look after their own skin. How can I stop getting cellulitis again? There are several things that we can do to lower the likelihood of a repeat cellulitis infection following the first episode: Take the full course of antibiotics your doctor has prescribed for the infection. If you get any new cuts or wounds to your skin, keep them clean and dry. Look out for any other types of skin infections such as athlete's foot, or any other conditions that can harm the skin (e.g. eczema) and get them treated by your doctor. (Athlete s foot often presents as dry and cracked skin in and around a person s toes) Use a moisturiser on your skin to prevent it becoming too dry and cracking. Care for your feet and regularly clip your toenails. This is very important. If you are unable to do this yourself, or if you are struggling to reach areas of infected skin, make an appointment with your doctor for a referral to a specialist in foot/leg care (podiatrist). Once you have seen the specialist you can make regular appointments to have your legs and feet cared for. Clean your hands regularly with soap and water, especially after touching infected skin. Talk to your doctor about losing weight. Overweight or obese people are more likely to develop new or recurrent cellulitis infections. If you have any other conditions that increase your risk of getting cellulitis, check with your doctor that they are being properly controlled. Examples include diabetes, heart failure, liver failure or problems with the circulation of your blood.

7 Page 7 of 8 Talk to your doctor about taking a long term course of antibiotics to help prevent the cellulitis coming back. A recent study has shown that this can lengthen the time between infection and re-infection in people who have a history of recurrent cellulitis. (N Engl J Med May 2;368(18): ). (unless otherwise stated, all information taken from uptodate.com patient information articles on cellulitis (the basics and beyond the basics) and the article written for doctors entitled Cellulitis and Erysipelas rovider). Contact us For more information please contact: Infection Prevention Team (Hospital queries) (08:30 to 16:30 Mon-Fri) Or (Hospital queries) Health Protection & Control of Infection Unit (Community queries) (08:30 to 16:30 Mon-Fri) Or (Community queries)

8 Page 8 of 8 If you would like this leaflet in a different format, for example, in large print, or on audiotape, or for people with learning disabilities, please contact: Patient and Customer Services, Poplar Suite, Stepping Hill Hospital. Tel: Information Leaflet. Our smoke free policy Smoking is not allowed anywhere on our sites. Please read our leaflet 'Policy on Smoke Free NHS Premises' to find out more. Leaflet number Intranet Office will supply Publication date August 2013 Review date August 2015 Department Infection Prevention Location Stepping Hill Hospital

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