DEAR DOCTOR: It took visiting four different doctors to get an accurate diagnosis of cellulitis. From what I've read, that's pretty common. There are many troubling things about it, including recurrence. Would you please cover it in your column?
DEAR READER: Cellulitis is a condition that occurs when bacteria find a way into the deeper layers of the skin and the layer of fat just beneath them, causing a spreading infection. (And to be clear, this has nothing to do with cellulite, a term for areas of skin that appear lumpy or dimpled due to subcutaneous fat distribution.)
Most often, cellulitis is caused by the strep or staph bacteria that are naturally present on the skin's surface. Many other bacteria can cause the condition, too. In cellulitis, bacteria typically enter the body through breaks, cracks, cuts or abrasions to the skin. Conditions such as athlete's foot, psoriasis, eczema, shingles and even dry skin can also provide entry points. Individuals with lymphedema, which is the buildup of fluid in soft body tissues due to damage or blockage in the lymphatic system, and edema, which is swelling due to excess fluids trapped beneath the skin, are also at higher risk of cellulitis.
While cellulitis can occur anywhere, it is most often seen on the legs and feet. Symptoms often begin with an area of red, tender skin, which usually expands beyond its starting point. Swelling, local warmth and pain, all signs of inflammation, are also common. In some cases, people with cellulitis will respond to the infection with fever, chills, swollen glands or swollen lymph nodes. The condition usually affects only one side of the body at a time.
Although cellulitis can occur in anyone, risk factors for the condition include a weakened immune system, IV drug use and diabetes. The latter is due to two factors. One is diabetic neuropathy, which is damage to the peripheral nerves. Neuropathy results in tingling and numbness, which can make it difficult to be aware of injuries. The other is high blood sugar, which impedes the effectiveness of the immune system.
You're correct that cellulitis is common. It's also potentially serious. That's because if left untreated, the infection can spread to the lymph nodes, bloodstream and deeper tissues of the body. When cellulitis is caught early and treated quickly, it can generally be cleared up without long-term complications.
Treatment consists of antibiotics, as well as measures to reduce swelling and increase circulation. These include compression and elevation to address swelling, and cool compresses, which can help relieve pain and itching. Because some conditions make it more difficult for the body to fend off ongoing or new infections, recurrent episodes of cellulitis can be common. It's important to always finish the entire course of antibiotics that has been prescribed, even if the infection appears to have cleared up. Keep skin clean and well-moisturized in order to prevent cracks or splits. If signs of a recurrence flare up, see your family doctor right away.
Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health.