Cellulitis

What is cellulitis?

Your skin is made of many layers. An infection in the deep layers and surrounding fatty tissue is known as cellulitis.

How have I got cellulitis?

Your skin acts as a barrier against infection. It usually does this without any problems.

Everyone has bacteria that lives on their skin. Most bacteria are harmless and many of them help keep your skin healthy.

If your skin becomes damaged, such as by a small cut or graze, bacteria can get into these areas and into the lower levels of the skin. This can cause infection.

Is there anything that would make me more likely to get cellulitis?

Healthy people, who do not have any illnesses can, and do, get cellulitis.

However, there are health conditions and other things that can make you more likely to get it. These can include:

• cuts or abrasions (such as a “skinned” knee or elbow)
• skin illnesses such as eczema or psoriasis
• chronically swollen legs or arms because of heart failure, lymphoedema and other reasons
• being overweight or obese
• athletes foot – this is a fungal infection of the skin of your feet
• animal or insect bites
• if you have had cellulitis in the past
• having an underactive immune system – This may be due to taking medicines, which can suppress your immune system, or due to illnesses, which can reduce you immunity.
• having poorly controlled diabetes
• being pregnant
• being an intravenous drug user.

Where on my body can I get cellulitis?

Cellulitis can affect any part of the skin on your body. The most common areas are your lower legs. Less commonly, it can develop on your arms or torso.

Rarely, it can affect your face or around your eyes. These sites can be the most serious.

What are the symptoms of cellulitis?

The most common symptoms of cellulitis are:

• redness, swelling and warmth of the skin
• pain which can be very severe
• ulcers or blisters in the skin.

You may have other symptoms that can include:

• lymphangitis – these are red streaks reaching up from the area of cellulitis and are caused by the infection spreading.

Is cellulitis serious?

In the majority of cases, cellulitis is not a serious infection and it can be treated with good skin care and oral antibiotics. For a small number of people, cellulitis can spread beyond the skin and cause an infection around your body. This is known as sepsis.

As well as changes to your skin, signs of a serious cellulitis infection can include:

• fever and flu like symptoms
• confusion, difficulty concentrating and sleepiness
• dizziness and having difficulty standing up
• passing urine less frequently
• very quickly spreading areas of cellulitis or a foul smell coming from the affected area.

Why are these symptoms concerning?

For a very small number of patients, cellulitis can turn into something more serious. These problems include:

• Blood poisoning (septicaemia or sepsis) can happen if bacteria spread from the cellulitis to the bloodstream.
• Abscess – In severe cellulitis, this can cause collections of pus which may require operations to drain
• Severe and rapidly spreading infections of the muscle and connective tissue. This is known as necrotising fasciitis.
• Infection of the bone underneath the cellulitis. This is known as osteomyelitis. This can happen if the cellulitis has developed in a deep skin ulcer.
• Infection spreading to other organs – very rarely, infection can spread from the skin to other organs and can cause heart, lung, kidney or other infections.

What tests will I have?

The Doctor or Nurse assessing you will listen carefully to you describe how you have been feeling. They will ask you questions about things that may have caused you to have cellulitis. They will also examine the area that has been affected.

They may also listen to your heart and lungs and examine your stomach if you have been feeling unwell.

You may also have other tests, depending on how unwell you are or how extensive the cellulitis is. These can include:

• Blood tests – These normally include tests of your full blood count, infection markers, kidney and liver function. These tests help to diagnose you and check that your organs are not being affected.

If you have been very unwell, the team may also take blood tests to check there is no infection in your blood stream

• Diabetes tests – The team may also check a test to screen for diabetes known as an HBA1C test
• ECG (heart tracings) – These may be taken if you are unwell or the measurements of your pulse or blood pressure are abnormal
• Swab tests – If you have cuts or ulcers in the area of the cellulitis, the team may take a swab to try to work out which type of bacteria has caused the infection. They will usually start treatment before the result is available, but may decide to change your treatment depending on the results of this test.

What is the treatment for cellulitis?

If your cellulitis is very mild or only affecting a very small area, you may not need any treatment at all.

The most important treatments for cellulitis are:

• Antibiotics – If the cellulitis is mild and you are well, you will have oral (tablet) antibiotics. In this Trust, the antibiotic we use is flucloxacillin

If you are penicillin allergic, you will be given clindamycin or teicoplanin. If you are allergic to both of these medicines, we will discuss your case with one of our specialist infection Doctors.

If your cellulitis is more extensive or you are unwell then you will be treated with drip (intravenous) antibiotics.

• Emollients – If your skin is dry or cracked, then we will normally prescribe you emollients (also known as moisturisers).This will allow your skin and infection to heal more quickly.
• Painkillers – Some patients do experience quite a lot of pain with cellulitis. This can make you less mobile and affect how you walk. This might make you less able to take care of yourself and slow down your recovery. If needed we will prescribe you painkillers to help with this.
• Medicine for a high temperature – Some patients with cellulitis may get a very high temperature. This can feel unpleasant. To help with this, you may be given regular paracetamol or other medicines such as ibuprofen.
• Tetanus vaccine – If you have developed cellulitis after a particularly dirty wound or injury from an animal who has been in close contact with soil or lives in an agricultural setting, you will receive a tetanus booster. You will only be given one if you have not had one within 10 years.
• Specialist nursing support – If your cellulitis has occurred around a skin ulcer, you may be assessed by a specialist nursing team known as the Tissue Viability service.

They will advise on what other treatments may help your ulcer to get better and what things can help to stop you from getting an ulcer in the future. They may ask your permission to take medical photographs.

Where will I have my treatment?

Oral treatment

If you are having oral treatment, you can have this in your own home.

Intravenous (drip) treatment

You may need to have intravenous antibiotics. This could be given to you as an outpatient and this would not require admission to hospital. This would depend on how well you are feeling.

This treatment will be co-ordinated through the Holdforth Community Hub in Hartlepool. The community hub will determine the most appropriate team to administer the antibiotics. The team giving you the treatment will follow a careful plan and check that the treatment is working.

Hospital treatment

Your team may wish you to have treatment as an inpatient in hospital if:

• you have signs of a severe infection
• you have other health problems which might be affected by the cellulitis
• you need antibiotics which cannot be given by the home intravenous antibiotic team
• they are concerned that the cellulitis  will make you unable to be able to safely take care of yourself.

If the team want you to have your treatment in hospital, they will explain the reasons why.

How long will I have treatment for?

Most patients will usually recover from the infection with 7 to 10 days of treatment.

If the cellulitis has been very severe, or if you have been unwell, you may be asked to have longer courses of treatment.

Are there any side effects of the treatment?

Most patients have no side effects from the treatment.

Antibiotics (especially if you need frequent courses or very high doses) can upset your gut and cause diarrhoea. If you experience this, please let the team know, as they may need to change your treatment.

All medicines can have other side effects. If you experience any new symptoms, please tell the team looking after you. This will allow them to assess whether it is a side effect of the medicine and whether they need to change your treatment.

Can I pass cellulitis on to anyone else?

No, the infection is deep within the skin and you cannot usually pass this on to another person.

Will this treatment affect any of my other medications?

Antibiotics can interact with other medicines. The team looking after you will carefully check all the medicines you are normally taking to make sure it is safe to take with the antibiotic.

Occasionally, some of the medicines that you are already taking may need to be stopped or the doses of these medicines may need to be changed while you are having treatment.

What can I do to help myself get better?

There are some things that you can do which will help you to get better more quickly. These include:

• Finishing your course of antibiotics. If you stop the treatment early, this can cause the cellulitis to come back.

This might also lead to the bacteria becoming resistant to the antibiotics that are usually used to treat cellulitis. This could mean that you may need to have different or longer courses of antibiotics.

• Check the area affected by cellulitis regularly – If you can, check the area of cellulitis at least once a day. If it is getting bigger or moving up your arm or leg, you should report this to your team immediately as you may need to have your treatment changed
• Drink plenty of fluids to keep yourself hydrated and your circulation healthy
• Rest and elevation – When you are starting on your treatment, it is important to rest and elevate your leg or arm. This involves raising the level of your leg above your hip, or your arm above the level of your heart
• Exercise – As you start to feel better, it is important to start to get to your normal day-to-day exercise and activities.

How do I know if the cellulitis is getting better?

• Pain – This should gradually start to settle and you should be able to stop any painkillers you have been taking
• Redness – The redness of the skin should start to return to your normal skin colour
• Skin temperature – The skin should feel less hot to touch and return to a more normal temperature
• Mobility – Your leg or arm should start to feel less stiff and you should be able to move it more normally
• If you had been having high temperatures or fevers because of the cellulitis, these should also settle down.

Can I get cellulitis again?

Yes. Cellulitis can come back. This is more common if you have any of the conditions that have been mentioned previously.

How can I cut down my chances of getting cellulitis again?

There are some things that can help cut down your chances of getting cellulitis again. These include:

• Smoking – stopping smoking can improve your circulation and cut down your chances of getting cellulitis again
• Clean any cuts or scrapes with antiseptic and cover them until they have healed. Check these areas regularly
• If you have dry or cracked skin, make sure you keep it well moisturised
• If you have any skin conditions such as eczema or psoriasis, make sure you take all of your regular creams and treatments. If these are not helping, you should speak to your GP as there may be other treatments that will work better.

These conditions can also be extremely itchy. Keeping your fingernails short can reduce the amount of scratching and damage you can cause to your skin.

• If you have diabetes, then it is important that you keep this as controlled as possible. Having frequent high blood sugars can increase your chance of developing cellulitis or other infections
• Other medications – Some illnesses need medicines that affect your immune system (immunosuppressants). This can increase your risk of cellulitis or other infections.

If you have had a very severe cellulitis (or more than one episode of milder illness), you must tell the team supervising your immunosuppressants. This will let them to decide if any changes are needed.

• Having a healthy weight – Being overweight or obese can increase your chances of developing cellulitis or slow your recovery from it. Keeping your weight at a healthy level can help recover and avoid this happening in the future. If you would like help to lose weight, speak to your GP.

What shall I do if I get frequent bouts of cellulitis?

Unfortunately, some people will be very prone to developing cellulitis, despite following all of the advice above. In these circumstances, they may be prescribed long-term antibiotics to cut down the chances of having cellulitis.

They may also be referred to a skin Doctor (Dermatologist) to check if any other treatments which might help.

Will I be left with any long-term side effects of celluitis?

Most people make a full recovery with no long lasting effects.

There are some rare side effects of cellulitis. These can be more common if you have had cellulitis more than once on the same area of your body. These include:

• Lymphoedema – Fluid is drained from the skin and tissues by your lymphatic system. The lymphatic system consists of a mesh of very fine tubes and channels under your skin. Cellulitis can damage this system. This can cause permanent swelling in the affected arm or leg

This is known as lymphoedema. Lymphoedema can be more prone to developing ulcers or cellulitis.

• Change in skin colour – an area of skin that has been affected by cellulitis can heal with a change in colour of the skin. The skin can appear darker (brown, pink or purple colour)

Over time, the skin usually returns to its normal colour. Some patients may be left with a permanent change.

Is it safe to drink alcohol if I have cellulitis?

In general, yes it is safe. However, cellulitis can be painful and make you more unsteady on your feet (especially cellulitis on your legs). Drinking alcohol at the same time may make you more likely to fall.

Can I travel while I have cellulitis?

Short journeys are safe and are usually no problem.

If you are having intravenous treatment, you may not be able to travel very far as you will need to be in your home at specific times of the day so that you can have your treatment.

The team giving this treatment will not be able to change the location where they give you your treatment.

Longer train or plane journeys may be very uncomfortable if you are still recovering from cellulitis. If you have not returned to your normal health, or if you are still having treatment, you may have a higher risk of developing blood clots in your legs or lungs during long journeys.

If you are uncertain, please consult the team looking after you, or your GP.

Can I drive if I have cellulitis?

If you are able to move your arm and leg without pain or limitation then you should normally be able to drive. If you have any questions please consult the DVLA.

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