Cellulitis is relatively common, with a crude incidence rate of approximately 259.2 cases for every 10,000 person-years, according to the Centers for Disease Control and Prevention. In most cases, a lower extremity is affected.
Cellulitis is a type of bacterial infection usually caused by Streptococcus pyogenes, but some infections are the result of Staphylococcus aureus. In recent years, cases of methicillin-resistant Staphylococcus aureus (MRSA) causing cellulitis has increased in incidence. MRSA is a more serious infection caused by Staphylococcus bacteria that is resistant to many of the commonly used antibiotics that are prescribed to treat ordinary Staphylococcus infections.
The bacteria can get in due to a break or crack in your skin. Common issues that can create a risk for this infection include recent surgery, puncture wounds, athlete’s foot, cuts or scrapes, a skin ulcer or dermatitis. To a lesser degree, dry skin can also put you at risk for cellulitis.
Cellulitis usually affects one side of the body. The following symptoms are possible:
- Skin redness that usually expands
- Tenderness or pain
- Fever
- Blisters
- Swelling
- Warmth
- Red spots
- Skin dimpling
When the infection is left untreated, it can spread to your bloodstream and lymph nodes. At this stage, it is considered to be life-threatening.
While rare, it is possible for cellulitis to spread to the fascial lining, which is a deep layer of tissue. This is considered a medical emergency when it happens. Those who experience cellulitis more than once are at risk for damage to their lymphatic drainage system. In these cases, there is the potential for the affected limb to experience chronic swelling. When caught early, the prognosis is generally good for most people. It is important to utilize the proper treatment to get the infection under control as quickly as possible.
1. Rest the Area
One of the most important treatment methods is making sure that the affected area is rested as much as possible. Proper rest is imperative, but how long should you rest the area and how should you balance activity? These are common questions.
As soon as the symptoms of cellulitis start, the affected area should be rested. This is especially important if your leg is affected since staying on it can contribute to additional swelling and discomfort. When the infected area has excess swelling, this can delay healing time. This is because proper blood flow is imperative for the affected tissues to heal since blood delivers oxygen and critical nutrients. When there is excess swelling present, it can slow how quickly blood is able to travel through the vessels.
It is generally recommended that you rest the affected area until you notice an improvement in your symptoms. However, if your doctor gives you a specific time frame, it is best to stick to it since they determined this based on your current condition and overall health.
When you are resting, this does not mean that you have to stay in bed 24/7. You can move around as needed to do basic activities of daily living, such as making food, using the restroom and attending to your hygiene needs.
2. Elevate Area
Temporarily elevating the affected area can help to alleviate swelling. This happens because with elevation, less blood is flowing to the area, allowing gravity to take over so that excess fluid can essentially drain away. In general, you want to elevate for cellulitis until the swelling starts to dissipate or as recommended by your doctor.
You should elevate the area enough to allow for fluid drainage, but not so much that you feel the area “falling asleep” and producing pins and needles sensations. If you experience these sensations, simply reduce the height of the elevation until the sensation goes away. Pillows are ideal for elevation since they are soft and should not cause discomfort.
3. OTC Pain Meds
If your pain is too much to tolerate, your doctor will usually recommend an over-the-counter (OTC) pain medication. There are three primary options, including aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen.
Acetaminophen can help to reduce fever and pain associated with cellulitis. This medication helps to relieve pain by acting on the brain areas responsible for receiving pain messages.
Aspirin and NSAIDs can reduce fever and pain, as well as inflammation, making them ideal if you also have swelling. Common OTC NSAIDs include naproxen and ibuprofen. These drugs help to alleviate inflammation and pain by reducing prostaglandin production. Prostaglandins cause pain and are a hormone-like substance.
4. Antibiotic Meds
Antibiotics are necessary to treat cellulitis since it is a bacterial infection. When caught early, most people are able to treat the infection with oral antibiotics. The general course is five to 10 days, but in some cases, you will need to take the medication for up to 14 days. The following oral antibiotics are commonly used for cellulitis:
Penicillin
Flucloxacillin
Cefalexin
If oral antibiotics do not clear the infection or if you have a very high fever, intravenous antibiotics might be needed. You will typically remain in the hospital while receiving IV antibiotics. If MRSA is determined to be the causative bacteria or if your infection is not resolving with one antibiotic, your doctor might choose to use a combination of them.
5. Cool Damp Cloth
Cellulitis can be painful, and the infected area can become warm. A cool damp cloth can help to soothe the warmth and pain. If there is a break in the skin or a wound, it is best to use sterile gauze and cooled sterile saline for this purpose to keep the wound or break as clean as possible.
It is important to not use ice on the infected area. Ice packs have the potential to cause ice burn which can damage the skin structure. This puts you at risk for further infection and complications. Ice can also reduce blood flow to the area which could inhibit healing.
6. Compression Wraps
Compression wraps are commonly used treatments for cellulitis, especially when the infection is in a limb. The purpose of compression wraps is to alleviate or prevent swelling. When you compress the area, it helps to influence the body to reabsorb any excess fluid that is present so that swelling decreases. With continued compression, fluid will not be able to reaccumulate and cause swelling to remain or recur.
When using compression, it should be snug, but not too tight. Make sure that you do not experience any tingling, numbness or coldness. If these symptoms occur, loosen the compression because these symptoms indicate that blood flow is interrupted.
