Cellulitis Patient information Leaflet Leaflet no: GMed 005 Version 1.2 October 2013
What is Cellulitis? Cellulitis is a bacterial infection of the deep layer of skin (dermis) and the layer of fat and soft tissues (the subcutaneous tissues) that lie underneath the skin. This infection can make your skin red, swollen and painful. Cellulitis is not the same as cellulite. Cellulite is a cosmetic problem that is caused by fatty deposits that form under the skin and has no relation to cellulitis. There are several types of bacteria that live on the surface of the skin. Usually, bacteria does not cause any harm although if this bacteria enters deeper into the skin, it can cause an infection. These bacteria can enter the body through a damaged or broken area of skin, such as a cut, graze or a bite. Also if you have a skin condition such as eczema, your risk of bacteria entering your skin is increased. Once bacteria is inside the skin, it starts to produce substances that break down the natural barriers that normally prevent bacteria from spreading into the deeper tissue. This assists the infection and inflammation to spread. Cellulitis is a common condition and most cases can be treated using antibiotics. However in more serious cases treatment in hospital may be needed. Symptoms Cellulitis most commonly affects one of your legs, but symptoms can develop in any area of your body. The condition affects your skin in several ways, causing it to become: Red, Painful, Hot Swollen and Tender. Sometimes if you have cellulitis you may find that blisters develop on your skin. Cellulitis can make you feel generally unwell, causing symptoms such as: Fever, Nausea, Shivering and Chills. These symptoms may occur before or after your skin symptoms develop. Swollen glands Sometimes, cellulitis can also cause your lymph glands (part of your body s immune system) near to the affected area to become swollen and tender. For example, if you have cellulitis in you leg, the glands in your groin may swell. This is because your lymph glands are trying to fight off the cellulitis infection to stop it spreading to other parts of your body. Cellulitis Page 2 of 7
Causes - Bacteria Cellulitis is caused by a bacterial infection of the skin and the tissues underneath it. The Streptococci, or staphylococci, groups of bacteria are the most common cause of infection because these bacterium already live on the skins surface. Cellulitis usually occurs when the surface of your skin becomes damaged because this creates an entry point for the bacteria, allowing it to attack the skin and tissue underneath. A break in the skin may be caused by a: Cut, Graze, Burn, Bite, Skin ulcer, or a Skin condition, such as atopic eczema (an itchy skin condition that causes the skin to become dry, red and cracked), or athletes foot. Some people who develop cellulitis do not have an identifiable wound, or break, in their skin. In such cases, the infection is usually introduced via the blood, or the lymphatic system (a series of vessels and glands that is part of the immune system), and this can be serious. What Are The Benefits? Diagnosis A doctor will diagnose cellulitis normally by assessing your symptoms. Before a diagnosis is made the doctor may have to rule out other conditions which may cause your skin to become swollen and inflamed, for example as with varicose eczema, (which causes itchy skin to become inflamed and can lead to skin ulcers). If you have an open wound the doctor or nurse may take a swab from your wound for assessment, this will assist the doctor to see the type of bacteria that is causing the infection. Normally there are no other tests that will need for cellulitis. Treatment - Antibiotics Cellulitis in most cases is treated with antibiotics. Cellulitis usually responds quickly to antibiotics and you should soon find your symptoms easing. Your skin may initially become redder when you start to take the antibiotics, but this reaction is normally only temporary. The redness should start to fade within 48 hours. The most commonly prescribed antibiotic medicine for cellulitis is flucloxacillen. However if this is not suitable for you, the doctor may prescribe erythromycin as an alternative. You normally have to take these antibiotics for seven days. In rare cases, you may have to take two types of antibiotic at the same time. You will normally only have to do this if your skin has been infected with contaminated water. If this is the case you may be prescribes another antibiotic or a combination with one of the above antibiotics. Cellulitis Page 3 of 7
Pain relief If cellulitis is causing you pain, or fever (temperature), taking an over-the-counter (OTC) pain medication may help to ease your symptoms. Paracetamol and ibuprofen are suitable forms of painkilling medication for cellulitis. The doctor will decide and prescribe these medications whilst you are in hospital. Ibuprofen should not be taken if you have or had in the past stomach problems, such as peptic ulcer. It is also not suitable if you have asthma. Are There Any Risks Involved? Complications In most cases cellulitis can be effectively treated using antibiotics and will not result in any complications, or long-term health problems. In a small number of cases, cellulitis can lead to serious complications, particularly if left untreated. Septicaemia If the bacteria which infects your skin gets into your bloodstream, this can lead to a condition which is known as septicaemia (blood poisoning). These symptoms can include: Fever, Fast heart beat, Breathing fast, Low blood pressure (hypotension), which can cause you to feel dizzy when you stand up, A change in your normal behaviour such as confusion or disorientation, Diarrhoea, Reduced urine output, Cold, clammy skin, Pale coloured skin and Reduced conscious level. Infection in other parts of the body In rare cases, the infection that causes cellulitis can spread to other parts of your body. In serious cases, the infection may spread to your: Muscle Bone, or Heart valves. Infection in these areas can be serious and will need intensive treatment. However, it is important to be aware that is rare, and most cases of cellulitis will not spread from original location. Swelling If you have cellulitis and it remains untreated, your risk of developing permanent swelling in your legs, or other affected body part, may increase. This is an advanced infection can stop lymph (the fluid which surrounds your tissues) from draining away. Cellulitis Page 4 of 7
There are a number of factors, and other conditions, which may increase your risk of developing cellulitis. Some of these factors are outlined below. Obesity Being overweight can cause swelling in your legs, which may increase your risk of developing cellulitis. A weakened immune system Your immune system may be weakened is you are under going chemotherapy, or you have a condition such as HIV, or AIDS. If your immune system is weakened, it makes it harder for your body to fight off infection. Poorly controlled diabetes If you have diabetes that is not being adequately treated, or controlled, it can weaken your immune system. Poorly controlled diabetes can also affect your circulation. Circulation Having poor circulation can increase your risk of developing skin infections in the places where your body does not have adequate blood supply. Chickenpox and shingles Chickenpox and shingles often cause blisters to develop on you skin. If the blisters are broken, or scratched, it can damage your skin, and provide an entry point for bacteria. Lymphoedema Lymphoedema is a condition that causes fluid to build up under the skin. If your skin becomes very swollen, it may crack, creating an entry point for bacteria. Previous episodes of cellulitis If you have had a previous episode of cellulitis, your risk of having further episodes in the future is increased. Intravenous drug use People who inject illegal drugs have an increased risk of developing cellulitis because poor needle hygiene can increase the risk of infection. What Are The Alternatives? There are no alternatives to treatment, although patients can assist with the care of cellulitis by: Self care If you have cellulitis, there are some things that you can do in order to ease your symptoms and could speed up your recovery. You should drink plenty of water to help prevent dehydration. If it is your leg that is affected by cellulitis, you should keep your leg elevated, this should make it feel more comfortable and help reduce the swelling. Cellulitis Page 5 of 7
How Long Will I Be In Hospital For? If your cellulitis is particularly severe, you may require hospital treatment. You may be admitted if: Your cellulitis is severe, or rapidly deteriorating, You have secondary symptoms such as fever, or vomiting, You fail to respond to antibiotics, You have cellulitis on a recurring basis. Once you are in hospital, you will normally need antibiotics to be given intravenously (through a vein in your arm). Day To Day Living Prevention Not all cases of cellulitis can be prevented. However, there are some steps that you can take to help reduce the risk of developing the condition, as well as other forms of infection. Treating skin wounds Make sure that any cuts, grazes or bites that you get keep them clean. Wash the damaged skin under running tap water and if needed, apply an antiseptic cream. The wound should be kept covered, either with a plaster or dressing, if it becomes wet, or dirty. Plasters and dressings will help reduce the risk of scratching, and they will also help to create a barrier against bacteria entering the skin. Keep your fingernails short If you have an itchy skin condition, like atopic eczema or chickenpox, you should keep fingernails short and clean all the time. If you do scratch your skin, and your fingernails are short and clean, the risk of skin damage and infection will be reduced. You should also wash your hands at regular intervals. Keep your skin moisturized If your skin is dry, or prone to cracking, make sure that you keep your skin moisturized. Cracked skin can create an entry point for bacteria. If There Is A Problem If you have any problems concerning your procedure please contact either your G.P or telephone the hospital on 0161 922 6000 and ask to be connected to the ward or department where the procedure took place. Alternatively if you are very concerned please attend the Accident and Emergency Department. Other useful contacts or information NHS Direct: Tel 0845 4647 http://www.nhsdirect.nhs.uk./ If you have any questions you want to ask, you can use this space below to remind you Cellulitis Page 6 of 7
If you have a visual impairment this leaflet can be made available in bigger print or on audiotape. If you require either of these options please contact the Patient Information Centre on 0161 922 5332 Document control information Author: J. Butterworth (Staff Nurse) / L. Penny (Matron) Division/Department: GMED Date Created: February 2010 Date Reviewed: October 2013 Reference Number: G.med 005. Version: 1.2 Cellulitis Page 7 of 7