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Cellulitis refers to an infection of the skin; the dermis, and subcutaneous tissue due to bacteria. It can also affect fat and soft tissue underneath. The infection penetrates deeper layers through bites, abrasions, cuts, or grazes. Chronic untreated cellulitis can be a life-threatening condition that can spread to lymph nodes and the bloodstream. It is not a contagious infection. It is a localized skin infection caused by inflammation and creates systemic complications. Cellulitis commonly occurs on the legs, but it can also occur on the face, arms, and other body parts. It appears as red, painful swelling, which is hot on the touch. Cellulitis is different from Cellulite (harmless peel on thighs and upper arms). Adults commonly get cellulitis on the legs, whereas children get cellulitis more often around the neck and face.


Cellulitis is divided into different types depending on the site of occurrence of infection. Some types of Cellulitis are:

1.       Periorbital Cellulitis: Cellulitis around the eyeball is called Periorbital Cellulitis.

2.       Facial cellulitis: Cellulitis around the eyes nose and cheek is called Facial Cellulitis.

3.       Perianal Cellulitis: Cellulitis around the anal opening is called Perianal Cellulitis.

4.       Breast Cellulitis: Cellulitis around the breast tissue is called Breast Cellulitis.


Some causative factors of Cellulitis are:

  • Infection by streptococcus pyogenes (two-thirds of the cases)
  • Infection by Staphylococcus aureus (one-third of the cases)
  • Haemophilus influenza cause facial cellulitis in children.
  • Animal bite (cat or dog)
  • Leech bites
  • Coral injury
  • Surgical wound
  • Insect bite
  • Bee or wasp sting
  • Scabies
  • Athletes foot
  • Eczema
  • Psoriasis

Risk Factors

Some major risk factors that prone the body to acquire cellulitis are:

  • Increasing age
  • Chronic skin issues
  • Lymphoedema
  • Edema of legs
  • Injuries
  • Recent surgery
  • Intravenous drug abusers
  • Poor blood circulation
  • Ulceration
  • Diabetes
  • Alcoholism
  • Obesity
  • Pregnancy
  • Immunocompromised
  • Previous Chronic Cellulitis
  • Poor circulation of limbs
  • Swelling of legs
  • Fractures
  • Bone infections
  • Chickenpox
  • Dry skin
  • Punctured wounds
  • Varicose veins
  • Chronic hepatitis
  •  Cirrhosis


It occurs mostly in middle-aged people and older adults. There are almost 14.5 million cases in the United States every year. Incidence is higher in males than Females. It is common in Asia for people between the ages of 45 to 65 years.

Signs And Symptoms

Mild cases could be restricted to localized infection, whereas rapidly spreading infection can result in sepsis. Dissemination of infection depends on the person’s immune system. Some common clinical features are:

  • Red marks, bruises
  • Fever, chills, and rigors (indicate bacteremia that is bacteria in the bloodstream)
  • Warmth
  • Skin wrinkling
  • Pain and tenderness
  • Swelling
  • Blisters
  • Erosions.
  • Ulcerations
  • Abscess formation
  • Hemorrhagic bullae
  • Purpura
  • Swollen lymph glands
  • Headache
  • Nausea
  • Fatigue
  • Chills and cold sweats
  • Fainting
  • Leaky fluid or pus
  • Numbness

Decreased pain, reduced swelling, Diminished redness or inflammation, and lesser firmness around the site of infection indicate the healing stages of cellulitis.


Diagnosis usually depends on the physical examination, but some important investigations include:

1- Swab test: To identify the causative organism.

2- Biopsy: Skin scrapings can be sent to the laboratory for detailed examination.

3- CBC: Complete blood count reveals increased White Blood cells.

4-CRP: Increased C-reactive protein in the blood test can indicate infection.

5- Culture of blood

6- X-ray if the foreign object is under skin or bone.

Differential Diagnosis

There are certain infections mimicking cellulitis but are referred to as psedocellulitis. They include:


  • Inflammatory breast cancer
  • Skin damaged by radiotherapy
  • Insect bite and stings
  • Thrombo phlebitis
  • Psoriasis
  • Fungal infections like tinea pedis tinea corporis
  • Drug eruption
  • Deep vein thrombosis
  • Dermatitis
  • Eczema


Cellulitis is an infectious disease that can be cured well if treated vigilantly and on time. Some of the treatment options include:

People with mild Cellulitis are treated with Oral antibiotics for five to 10 days. Antibiotics are continued for a long period for mild chronic infections, sometimes for several months.

Severe Cellulitis is treated with intravenous antibiotics, Plenty of fluids, and Oxygen, When signs and symptoms are not responding well to the oral antibiotics.

The selection of antibiotics depends on the culture, swab, or biopsy reports.

Some antibiotics include penicillin, amoxicillin, clavulanic acid, cephalosporins, clindamycin, Sulfamethoxazole/trimethoprim, doxycycline, vancomycin, linezolid, ceftaroline, daptomycin.

Cellulitis surgery may be required to drain the abscess or pus in the tissue in severe cases.

Some important strategies to enhance recovery are;

  • Treating the affected area by applying a cool damp cloth
  • Avoid compression stockings even if the infection is resolved.
  • Try Painkillers (Analgesics) for pain and fever. For example, ibuprofen or acetaminophen.
  • Take care of hydration by drinking plenty of water.
  • Move the affected part to prevent swelling and stiffness as the blood circulation increases by movement.
  • Raise the affected part to improve circulation.

If symptoms get worse, don’t hesitate to contact a doctor. 

Sometimes cellulitis can progress to severe illness and cause complications. Some of the local complications include Gas gangrene, abscess formation, or Necrotizing fasciitis, which is a debilitating soft tissue infection causing severe pain, reduced skin sensation, ulceration, and necrosis requiring amputation. Some infectious agents, like,  group A beta-hemolytic Streptococcus and S. Aureus, can produce toxins that may spread uncontrollably via blood or lymphatics, resulting in sepsis or shock. It can also affect:

Kidneys result in renal failure and hypotension, ultimately leading to loss of consciousness and collapse. 


Cellulitic infections are usually treated well, resulting in a complete cure. Mild infections can be treated in the outpatient department with oral antibiotics and home care advice. If the infection is severe, you may need to be admitted to a hospital and treated with IV antibiotics and more vigilant care. 


Taking care of a few things can prevent you from getting cellulitis like;

  • Maintaining a good skin hygiene.
  • Taking good quality food and performing the exercise to control weight.
  • Avoid smoking.
  • Limit alcohol use.
  • Protection of skin by wearing proper long sleeves clothing.
  • Acquire medical evaluation for wounds for the signs of infection.
  • Bandage covering of wound.
  • Avoid scratching and itchy bites.
  • Treating cuts and bites soon reduces the chances of infection.

Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on April 29th, 2023.





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