Let’s Talk About Cellulitis Treatment
This bacterial skin infection can be dangerous. Fortunately, there are expert-proven ways to fight back.
Your doctor took one look at the red spot on your lower leg and knew exactly what it was. Your next stop: the pharmacy to pick up your script for antibiotics to treat cellulitis. The good news is that you caught this bacterial skin infection early and your doctor says treatment will help you feel like yourself in no time. But what’s actually involved in treating it? Here’s a breakdown of what the healing process can include.
Our Pro Panel
We went to some of the nation’s top cellulitis experts to bring you the most scientific and up-to-date information possible.
Gina A. Suh, M.D.
Infectious Diseases Specialist
Jun Kevin Kang, M.D.
Assistant Professor of Dermatology
Johns Hopkins Medicine
Ohara Aivaz, M.D.
Los Angeles, CA
Cellulitis is treated with antibiotics. If you catch it early before it has started to spread, a 5- to 7-day course of antibiotics taken orally should do the trick.
If oral antibiotics don’t help clear your cellulitis, your doctor may choose intravenous (IV) antibiotics that are given in the hospital. You may undergo some testing to identify the type of bacteria responsible for your infection.
In addition to taking your antibiotics as directed, keep the affected limb elevated to reduce any swelling. You can take over-the-counter pain medications and also place a cool, damp cloth over the area.
Find out why you got it in the first place and take steps to treat any underlying condition that may predispose you to cellulitis, such as diabetes, athlete’s foot, eczema, or lymphedema. It’s also important to take care of cuts and wounds early.
Remind Me, What Is Cellulitis?
Cellulitis is a common bacterial infection that begins when the surface of your skin is broken and bacteria move in. It occurs in the deeper layers and tissues of your skin and results in more than 14 million cases in the U.S. every year. Common bacterial culprits include Streptococcus (strep) and Staphylococcus (staph), but MRSA (methicillin-resistant Staph aureus, a kind of staph infection that’s resistant to some antibiotics and harder to treat) and other bacteria can also cause this pesky infection.
Cellulitis affects both men and women equally, and while it’s most often found in those who are middle-aged and older, you can still get it at any age. The common denominator: An open wound on your skin surface.
The first thing you’ll likely notice with cellulitis is a red patch or area. The red area is usually pretty close to the source of the cut, scrape, or wound. You’ll notice that the red spot may be warm to the touch, swollen, and painful. You may also start to feel under the weather and experience fever, nausea, and/or chills.
Cellulitis typically shows up on a lower leg or foot, largely because of pre-existing conditions that affect this part of the body that make you more predisposed to cellulitis. This includes athlete’s foot, diabetes, and lymphedema (swelling that occurs when excess lymph fluid collects in soft tissues). However, any body part is fair game for cellulitis.
If not caught early, cellulitis can spread and infiltrate deeper tissues and ultimately get into your bloodstream, causing infection in other areas of your body, such as your joints, bones, and/or organs, including the lining of the chambers of your heart and heart valves (a dangerous condition called endocarditis). Although rare, cellulitis may also lead to a very serious infection called necrotizing fasciitis, or flesh-eating disease. This is why early diagnosis and treatment makes a big difference in your outcome.
How to Treat Cellulitis
When you catch cellulitis early, your doctor will likely prescribe oral antibiotics for five to seven days to clear up the infection. Chances are that your doctor will prescribe antibiotics that target the main bacterial offenders—staph and strep. Options for this include:
If you have an underlying disease or take medication that compromises your immune system’s ability to fight infections, your doctor may choose a stronger antibiotic that covers MRSA right off the bat, since, as its full name implies, the MRSA infection is resistant to some antibiotics. It’s also a lot more aggressive than other infections, so prompt action is needed to stem it.
You should start feeling much better within a day or two, and your rash should also start to shrink, but it can take up to two weeks to fully recover. You can help minimize swelling by keeping the affected area elevated. If it is painful, place a cool, damp cloth over it and/or take an over-the-counter pain medication.
It’s important that you take your antibiotics as directed for as long as directed—even if your rash is gone and you feel good as new again. If you don’t finish the entire course, the bacteria won’t be fully destroyed, and your chances of getting sick again are higher because the infection was never fully resolved.
There’s also a risk that the cellulitis-causing bacteria will mutate or morph and grow resistant to the antibiotic, and that antibiotic may not work for you in the future. Such antibiotic resistance has been linked to the development of “superbugs,” which is a true global health concern, so you’ll want to be sure to take your antibiotics as directed.
Treating Treatment-Resistant Cellulitis
If you’re not improving—or if you are getting worse—after three days on oral medication, you may need a stronger antibiotic that targets other types of bacteria. At this point, your doctor may order a culture to identify what type of bacteria is causing the infection. It’s a pretty simple process: Your doctor uses a sterile swab to get a sample of the pus or tissue cells and then sends it off to the lab to be analyzed.
You may need to get antibiotics delivered intravenously (via an IV) if you have a more serious infection. Based on your condition, your doctor will decide if you can get this or other treatment as an outpatient, or if the cellulitis has spread so much that it’s better for you to be admitted to the hospital for treatment. Antibiotics that are given intravenously are stronger and work more quickly than their oral counterparts. Options include:
If you are getting better from the IV antibiotics, you may be switched to oral antibiotics.
Cellulitis Medication Side Effects
Like all medications, antibiotics have their own share of side effects, ranging from minor issues like rashes or an upset stomach to more serious issues like antibiotic-resistant infections. You’ll want to work with your doctor if you begin to experience discomfort.
Common side effects from antibiotics may include:
Diarrhea, including potentially life-threatening diarrhea caused by the bacteria Clostridium difficile (C. diff)
Treating Cellulitis-Related Health Conditions
Certain underlying diseases and conditions, including lymphedema, athlete’s foot, eczema, and diabetes, all increase your risk of developing (or redeveloping) cellulitis. Keeping these conditions well-controlled will help prevent future bouts.
If you have diabetes, you need to maintain tight control of your blood sugar, since bacteria love to feed on sugar. If you have diabetic nerve damage—which affects your ability to feel your feet and makes you less likely to notice any cuts or scrapes that can then easily become infected—it’s particularly important to check your feet daily (don’t forget to look between your toes, too!) for cuts or wounds. Also, make sure to see your podiatrist at least once a year for the most thorough foot care.
If you have lymphedema—a chronic condition whereby excess fluid collects in tissues, causing swelling and setting the stage for cellulitis—you may also need specific management strategies from your doctor. The lymphatic system is a part of the immune system, and when it isn’t functioning properly, you’re more prone to infections like cellulitis.
The swelling caused by lymphedema also stretches the skin, making it more likely to crack and tear and let bacteria in. Once germs enter, your immune system isn’t up to task, so it can’t properly handle this threat. Compression stockings or sleeves can help reduce swelling and related stretching of the skin that may set the stage for cellulitis. These garments apply pressure that encourages the lymph fluid to keep on moving and doing its job. Ask your doctor if a compression garment should be part of your plan and for suggestions on brands and styles.
If you have athlete’s foot, know that this condition may lead to tiny tears on the soles of your feet or between your toes, which provide bacteria with a portal of entry. Treating athlete’s foot with an antifungal, making sure you keep your feet clean, and always wearing shoes around swimming pools and at the gym can help keep athlete’s foot—and cellulitis—at bay.
If you have eczema, an inflammatory skin condition that causes tiny cracks in your skin, your skin’s barrier is compromised, rolling out a red carpet for bacteria. Regular moisturizing can help keep your skin in tip-top shape and prevent eczema flares, along with reducing your risk for cellulitis.
There are other reasons you may be more susceptible to cellulitis. Your immune system may be compromised for many reasons, including use of steroid medicines, chemotherapy to treat cancer, other medicines that suppress the immune system, and/or certain underlying diseases and conditions.
If you are overweight, poor circulation in your arms, legs, hands, or feet due to excess weight can cause swelling, which sets the stage for cellulitis.
Heart surgery that involves having a vein removed from your leg and reconnecting it to your coronary artery to boost blood flow to your heart may also increase your risk of cellulitis, as it can cause leg swelling.
Once you have had cellulitis, your chances of getting it again are greater if you have any of those underlying conditions that can make you more susceptible to it, but taking steps to prevent infection can go a long way. Any time you find a minor cut or scrape, make sure to wash it thoroughly with soap and water, apply an antibacterial ointment, and keep it covered with a bandage until it’s healed. This is the best way to prevent infection. If the wound is deep, call or see your doctor for instructions.
These are some other pointers for preventing cellulitis:
Use electric razors. Shaving can cause nicks that can lead to cellulitis if you are prone to the infection. Consider using an electric razor instead of a manual one, which can help you avoid nicks.
Wear compression socks. These leg or arm wrappings may reduce the swelling of lymphedema, which can help make you less prone to cellulitis.
Use antibacterial cleansers. Weekly antibacterial washes, such as using antibacterial soap from your neck down while in the shower, can also stop infections before they start.
Wash your hands. Scrub up often with soap and water or use an alcohol-based hand rub if you don’t have access to a sink and soap.
Stay out of hot tubs. And also pools, lakes, and other waterways, which may be teeming with bacteria if you have an open cut, as this is one way to get an infection.
If you keep getting cellulitis, it may be time for suppressive or preventive antibiotics. This involves taking antibiotics every day to stave off cellulitis. Of course, the benefits have to outweigh the risks, namely the potential to develop antibiotic resistance from their overuse. Antibiotics in this way are a last resort, but there are times when they are necessary.
The good news is that cellulitis is treatable and beatable, especially when you catch it early. Once you’ve had it, you are more likely to get it again, and that’s why prevention is so important. Keeping all cuts and wounds clean and all underlying conditions in check can break this vicious cycle.
Cellulitis Overview: U.S. National Library of Medicine. (2019). “Cellulitis.” https://www.medlineplus.gov/ency/article/000855.htm
Cellulitis Statistics: StatPearls. (2020). “Cellulitis.” https://www.ncbi.nlm.nih.gov/books/NBK549770/
Cellulitis Overview: Centers for Disease Control and Prevention. (2020). “Cellulitis.” https://www.cdc.gov/groupastrep/diseases-public/Cellulitis.html
Lymphedema: U.S. National Library of Medicine. (2020). “Lymphedema.” https://www.medlineplus.gov/lymphedema.html
Antibiotic Use: The Agency for Healthcare Research and Quality. (2019). “Best Practices in the Diagnosis and Treatment of Cellulitis and Skin and Soft Tissue Infections.” https://www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/best-practices/cellulitis-facilitator-guide.pdf
Cellulitis Overview: Centers for Disease Control and Prevention. (2020). “Cellulitis.” https://www.cdc.gov/groupastrep/diseases-hcp/cellulitis.html
Antibiotic Side Effects: Centers for Disease Control and Prevention. “Skin Infections.” https://www.cdc.gov/antibiotic-use/community/for-patients/common-illnesses/skin-infections.html
Athlete’s Foot: American Academy of Dermatology. “How to Prevent Athlete’s Foot.” https://www.aad.org/public/diseases/a-z/athletes-foot-prevent