Cellulitis is a bacterial skin infection in the deeper layer of the skin (i.e. fat and soft tissues). It can affect any part of the body, but most commonly occurs in the lower legs. It occurs when bacteria, typically Staphylococcus aureus or Streptococcus, enter the skin through a crack, cut or wound, or sometimes even a mosquito bite. If left untreated, the infection can spread to the lymph nodes and bloodstream and rapidly become life-threatening.

What are the symptoms?

• Redness and swelling of the affected area

• Skin that feels warm or hot in affected area

• Painful especially on touch

• Possible blisters or pus-filled bumps

• Fever, chills, or general malaise in severe cases

• “Red streaking” or tracking from the wound area (later stages)

Risk Factors

• Skin Injuries: cuts, scratches, insect bites, ulcers, animal bites or surgical sites.

• Weakened Immune System: due to diabetes, chemotherapy, or other conditions.

• Chronic Conditions: such as diabetes, lymphedema, or venous insufficiency.

• Edema: Chronic swelling in the legs.

• Fungal Infections (Athlete’s foot) and skin conditions (e.g. eczema): cracks in the skin increase susceptibility.

• History of cellulitis: having had cellulitis before increases the risk of getting it again.

• Being overweight: excess weight increases the risk of developing cellulitis.

How is cellulitis diagnosed?

Cellulitis is typically diagnosed through a physical examination. Additional tests (like blood tests or wound cultures) may be performed in severe cases to rule out other conditions or complications.

What are the treatments?

• Antibiotics: oral antibiotics are the primary treatment. Severe cases may require intravenous antibiotics.

• Elevation: raising the affected limb helps reduce swelling.

• Pain Management: over-the-counter pain relievers like paracetamol or ibuprofen.

• Monitoring: ensure symptoms improve with treatment; worsening symptoms require immediate medical attention.

How can cellulitis be prevented?

Sometime you cannot always prevent cellulitis from developing, but there are some ways to reduce the risk.

• Treat cuts and grazes: keep any cut, bite, graze, or wound — including those from a recent surgery — clean to reduce the risk of infection.

• Practice thorough hygiene: wash hands often, shower regularly, and wear clean socks and dry well between you toes and around feet.

• Avoid scratching bites, scratches, or eczema.

• Take care of the skin: moisturisers can help prevent dry skin from cracking and using antifungal as required

• Protect the skin: wear gloves and long sleeves while gardening, and avoid wearing shorts if there is a likelihood of grazing the skin

• Manage risk factors: for example, for diabetics- exercise regularly, manage blood sugar levels, and check feet daily. For people with lymphedema and venous insufficiency managing the fluid swelling via medically recommended compression garments.

 When to Seek Help

• Rapid spreading of redness or swelling

• High fever

• Pain that worsens or doesn’t improve

• Signs of systemic infection like confusion or lethargy

The Podiatrist's Role

As podiatrists, we often see cellulitis associated with foot and lower leg issues.

We provide:

• Preventive care: addressing risk factors like dry, cracked skin or nail issues.

• Early detection: recognising early signs of infection to prompt medical referral.

• Wound care: ensuring proper dressing and care for any breaks in the skin.

• Patient education: teaching strategies to maintain foot health and prevent recurrence.

Cellulitis can start and spread quickly, especially in people with the above risk factors. It is best to see a medical professional (i.e. GP or Podiatrist) as soon as symptoms appear, as there is a good chance that the treatment will be effective and stop the infection from spreading.  Although having cellulitis once increases the risk of getting it returning, precautions such as managing risk factors, skin protection and good hygiene practices can help to prevent reoccurrence.