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Table of Contents > Conditions > Cellulitis
Cellulitis
Also Listed As:  Skin Infection
 
Signs and Symptoms
What Causes It?
Who's Most At Risk?
What to Expect at Your Provider's Office
Treatment Options
Treatment Plan
Drug Therapies
Surgical and Other Procedures
Complementary and Alternative Therapies
Prognosis/Possible Complications
Following Up
Supporting Research

Cellulitis is an inflammation of the skin and the connective tissue beneath the skin, caused by a bacterial infection. Cellulitis most often affects the legs, but it may also affect the arms, face, and scalp. Generally, cellulitis is cured with antibiotics; however, the condition sometimes leads to serious complications.


Signs and Symptoms

Cellulitis is accompanied by the following signs and symptoms:

  • Pain and tenderness
  • Edema (swelling caused by fluid in the tissues)
  • Erythema (abnormal redness of the skin)
  • Skin that is warm to the touch
  • Fever
  • Chills

What Causes It?

Cellulitis is caused by a bacterial infection, most often by group A streptococci and Staphylococcus aureus. Other types of bacteria may cause cellulitis in children, people in specific occupations (such as fish and meat handlers), and those exposed to water in aquariums and swimming pools. In 50 to 60% of cases, the patient has had some kind of skin injury (for example, cuts, insect bites, trauma, burns, surgical incisions, intravenous catheters, dermatitis). Upper respiratory infections precede one third of erysipelas cases. Erysipelas is an acute, superficial type of cellulitis involving the lymph system. It is seen in infants, young children, and the elderly, and is generally caused by streptococcal infection.


Who's Most At Risk?

People with the following conditions or characteristics are at risk for developing cellulitis:

  • General weight loss and weakness, especially from chronic illness
  • Diabetes
  • Peripheral vascular disease
  • Malnutrition
  • Contaminated wounds
  • A weakened immune system
  • A general infection
  • Sinusitis, otitis media, or epiglottitis, especially in children
  • Lymphedema (accumulation of lymph fluid in the body's tissues) from surgery, radiation therapy, or cancer that has spread to lymph nodes
  • Animal bites
  • Vein surgery

What to Expect at Your Provider's Office

If you experience symptoms associated with cellulitis, you should see your healthcare provider as soon as possible. He or she will do a thorough physical examination to determine what is causing the condition and which antibiotic therapy to prescribe. Lab tests and imaging may also be used.


Treatment Options
Treatment Plan

Standard treatment includes antibiotics in combination with complete bed rest. It is important to elevate the affected arms or legs, to keep still, and to apply cool, wet, sterile bandages to relieve discomfort.


Drug Therapies

Your provider will prescribe the appropriate antibiotics for your infection as well as pain relievers if needed.


Surgical and Other Procedures

Surgery to drain any underlying abscess (infected tissue) may be necessary if antibiotics are not effective.


Complementary and Alternative Therapies

Because cellulitis can progress rapidly, it is important to start antibiotics as soon as possible. This may prevent complications from the skin and soft tissue infection. Most CAM therapies have not yet been studied for use in the case of cellulitis specifically. Several therapies, though, may reduce the risk of developing cellulitis or ease some of the symptoms when used in conjunction with conventional care.

Magnet therapy has been successfully used by some patients with chronic, recurring cellulitis, although there has been no scientific research to date to adequately test the value of this treatment. There are many theories about how magnet therapy works to reduce pain and inflammation. They include the idea that magnets improve circulation to the area by removing wastes and by delivering nutrients more efficiently. Magnets are also thought to lessen pain by altering the transmission of pain signals; by realigning the molecules in cell membranes, which may improve cell function; and by changing levels of enzymes and other chemicals in the body. Research is needed to explore these theories and the approach of magnet therapy for cellulitis and other conditions more fully.


Nutrition

Researchers have not studied the ways specific nutrients may affect cellulitis. However, zinc and vitamins A, C, and E are used to support the immune system. Vitamins A and E are also thought to benefit the skin. Flavonoids (compounds in such fruits as citrus, blueberries, grapes; in vegetables, including onions; and in tea and red wine) appear to help reduce lymphedema and to reduce the risk of cellulitis. Bromelain (250 to 500 mg three times a day) may be used to reduce inflammation and edema (swelling from fluid buildup); it works well when used with the flavonoid quercetin.


Herbs

While there are no scientific studies showing that herbs have a direct effect on cellulitis, the following herbs that support the immune system may be helpful:

  • Echinacea (Echinacea spp.) is widely used in clinics to boost the immune system in order to prevent infection. In addition, the World Health Organization (WHO) supports the use of Echinacea purpurea externally for treatment of inflammatory skin conditions.
  • Yarrow (Achillea millefolium) is approved in Great Britain for skin infections and inflammation; it is applied topically.
  • Comfrey root (Symphytum officinale) is an anti-inflammatory. Some clinicians suggest a paste can be made from comfrey root and placed on the affected area twice a day to speed healing. Goldenseal root (Hydrastis canadensis), which has both anti-inflammatory and antibacterial properties, andslippery elm (Ulmus fulva), an antiseptic, may be added to a comfrey paste to increase its beneficial effects.
  • Calendula flower (Calendula officinalis) is approved in Germany for topical application to leg ulcers (open wounds of the leg that can readily become infected).
  • Fenugreek seed (Trigonella foenum-graecum), which contains flavonoids, is approved in Germany for external use on skin inflammation and infections.

Homeopathy

French and Belgian homeopaths have been treating cellulitis with homeopathic remedies since the 1960s. Although very few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths would recommend the following remedies for the treatment of cellulitis based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type. A constitutional type is defined as a person's physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

  • Apis Mellifica -- for swelling with a puffy appearance that worsens with heat and pressure, especially in the afternoon and is better with cold applications, open air, movement, and sitting upright
  • Cantharis -- for restless and anxious individuals; may be used for children; only available under the direction of a licensed homeopath
  • Lachesis -- for symptoms that tend to be worse on the left side of the body and during and immediately after sleep
  • Mercurius -- for individuals who are bothered by both heat and cold, and are often trembling and impulsive
  • Rhus toxicodendron -- for individuals who are restless and anxious with itching that tends to worsen at night but is relieved by warm compresses or pressure
  • Sulphur -- for hot, burning skin with itching that worsens at night and with washing

Seek immediate medical attention if fever and swelling do not subside after 24 hours.


Acupuncture

Acupuncture and other Traditional Chinese Medicine practices may help address the underlying cause of cellulitis and may enhance the immune system. However, no scientific studies have investigated their uses specifically for cellulitis.


Massage

Massage should not be used if you have an active infection. However, massage that promotes lymph drainage, when used in conjunction with compression and exercise, may help prevent cellulitis.


Prognosis/Possible Complications

Antibiotics usually cure cellulitis. While complications are rare, they can be serious and even life-threatening if the infection spreads to the blood. Complications are more common in very young children, the elderly, or in people who have immune system disorders. Possible complications include abscesses, gangrene (tissue destruction), and thrombophlebitis (inflammation of superficial veins). Some people are prone to recurrence of cellulitis, often in the same area, leading to permanent skin changes. Gangrene may result in loss of a limb.


Following Up

Your healthcare provider should see you periodically to make sure you have no complications.


Supporting Research

Blumenthal M, Busse WR, Goldberg A, et al., eds. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, Mass: Integrative Medicine Communications; 1998:116, 121-123, 233-234.

Conn RB, et al. Current Diagnosis. Philadelphia, Pa: W.B. Saunders; 1997:1192.

Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. 3rd ed. New York, NY: Penguin Putnam; 1997:320, 331-335, 341, 345.

Fauci AS, Braunwald E, Isselbacher KJ, et al., eds. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998:829.

Keller KL, Fenske NA. Uses of vitamins A, C and E and related compounds in dermatology: a review. J Am Acad Dermatol. 1998;39(4 Pt1):611-625.

Mandell GL, et al. Principles and Practice of Infectious Diseases. 4th ed. New York, NY: Churchill Livingstone; 1995:913-919.

Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany, Calif: Hahnemann Clinic Publishing; 1993:27-29, 68, 97, 144, 171, 215-219, 246, 324, 327, 368-374.

Mortimer PS. Therapy approaches for lymphedema. Angiology. 1997; 48(1):87-91.

Moschella SL, Hurley HJ. Dermatology. 3rd ed. Philadelphia, Pa: W.B. Saunders; 1992:183, 223, 728-732.

Rosen P, et al. Emergency Medicine: Concepts and Clinical Practice. Vol. III. St. Louis, Mo; Mosby; 1998:2669-2672, 2862.

Sauer GC. Manual of Skin Diseases. 6th ed. Philadelphia, Pa: Lippincott; 1991:158.

Schwartz SI, et al. Principles of Surgery. 7th ed. New York, NY: McGraw-Hill; 1999:126-127.

Szor JK, Topp R. Use of magnet therapy to heal an abdominal wound: a case study. Ostomy Wound Manage. 1998;44(5):24-29.

Ullman D. Homeopathic Medicine for Children and Infants. New York, NY: Penguin Putnam; 1992: 147, 167-168, 214-216.

Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Penguin Putnam; 1995.


Review Date: October 2000
Reviewed By: Participants in the review process include: Jacqueline A. Hart, MD, Department of Internal Medicine, Newton-Wellesley Hospital, Harvard University and Senior Medical Editor Integrative Medicine, Boston, MA; Eric Wellons, MD, Department of Surgery, Union Memorial Hospital, Baltimore, MD; Leonard Wisneski, MD, FACP, George Washington University, Rockville, MD;

Copyright © 2004 A.D.A.M., Inc

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application, use, or misuse of any of the information contained herein, including any injury and/or damage to any person or property as a matter of product liability, negligence, or otherwise. No warranty, expressed or implied, is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor, pharmacist, nurse, or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage, precautions, warnings, interactions, and contraindications before administering any drug, herb, or supplement discussed herein.

 
RELATED INFORMATION
  Conditions with Similar Symptoms
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  Drugs
Antibiotics
Pain Relievers (Analgesics)
  Herbs
Calendula
Comfrey
Echinacea
Goldenseal
Slippery Elm
Yarrow
  Supplements
Bromelain
Quercetin
Vitamin A (Retinol)
Vitamin C (Ascorbic Acid)
Vitamin E
Zinc
  Learn More About
Acupuncture
Herbal Medicine
Homeopathy
Massage
Nutrition
 

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