Cellulitis | Pokenga kiri

(you say, sell-you-ly-tis)

Overview
Clinicians
Clinicians

Cellulitis (pokenga kiri) is an infection that affects the deeper layers of the skin. It needs treatment with antibiotics as it can be serious if not treated quickly.

On this page, you can find the following information:

What are the signs of cellulitis?
What causes cellulitis?
Who is at risk of cellulitis?
How is cellulitis treated?
What can I do to stop cellulitis recurring?
Cellulitis complications

Key points

Areas of skin affected by cellulitis become red, painful, hot and swollen.
Early treatment with antibiotics can stop the infection becoming more serious.
See a doctor (preferably today) if the affected area is bigger than a 10 cent piece.
Seek medical help straight away if the problem area is near your eye, if you have flu-like symptoms, if your immune system is weakened or if you are an older person or a child.
Go back to the doctor if the red area gets much bigger or deeper or if you have a fever. Cellulitis can spread to other parts of your body or to your blood. You may need blood tests and/or more antibiotics.
You can reduce the chances of getting cellulitis again by keeping your skin clean and well moisturised and treating any breaks in your skin.

What are the signs of cellulitis?

Cellulitis generally only affects one side of the body. The area of skin affected by cellulitis becomes red, painful, hot and swollen. Blisters may form and the affected area may grow larger. This can happen quite quickly, over hours to a few days.

You may also feel unwell and feverish with a high temperature and shivers. This may start a few hours or a day before the skin changes become visible.

When to seek medical help
See a doctor (preferably today) if the affected area is bigger than a 10 cent piece. Ask for an urgent GP appointment (straight away) if: your face or the area around your eye is affected the affected area grows rapidly and/or is extremely painful you develop a fever or flu-like symptoms you have a weakened immune system – for example, because of chemotherapy or diabetes a young child or older person has possible cellulitis. Early treatment with antibiotics can stop the infection becoming more serious.

When to seek medical help

See a doctor (preferably today) if the affected area is bigger than a 10 cent piece.

Ask for an urgent GP appointment (straight away) if:

your face or the area around your eye is affected
the affected area grows rapidly and/or is extremely painful
you develop a fever or flu-like symptoms
you have a weakened immune system – for example, because of chemotherapy or diabetes
a young child or older person has possible cellulitis.

Early treatment with antibiotics can stop the infection becoming more serious.

What causes cellulitis?

Cellulitis is usually caused by a bacterial infection. The bacteria are usually present on your skin without causing infection, but if they get through your skin (eg, through cuts, bites or dry, cracked skin), they can multiply and cause cellulitis. Sometimes the break in the skin is too small to notice.

Once the bacteria are in the skin, they cause redness and swelling that can spread rapidly.

You can't catch cellulitis from another person as it affects the deeper layers of the skin.

Who is at risk of cellulitis?

Anybody can get cellulitis. Some of the common things that make you more at risk of getting cellulitis are:

having had cellulitis before
having poor circulation in your arms, legs, hands or feet
difficulty moving around
being overweight
having a weakened immune system (eg, caused by uncontrolled diabetes or chemotherapy)
having a skin condition (eg, eczema, psoriasis, scabies or acne)
having athlete's foot (fungal infection of the skin between the toe webs)
having chronic swelling (lymphoedema, heart failure)
injecting drugs
having a wound from surgery
having a dental infection
having had an insect or animal bite.

How is cellulitis treated?

For mild cellulitis affecting a small area of skin, your GP will prescribe antibiotic pills. In more severe cases, you may need to go to hospital for intravenous antibiotics (injected). You may also be seen by a skin specialist, or by an eye specialist (ophthalmologist) if your cellulitis is near your eye.

Antibiotics

Make sure you understand how to take the antibiotics – how many times per day and what dose. Take the antibiotics every day until they are finished. It is important to do this even if the infection seems to have cleared up as there may be infection under the skin that you can’t see.

Note that the redness may continue to spread during the first two days of taking antibiotics. You should go back to the doctor if the red area gets much bigger or you have a fever. Cellulitis can spread to other parts of the body or to the blood. You may need blood tests and/or more antibiotics.

Your doctor may mark the edge of the red area with a marker pen. Do not wash this off. This is so your doctor can see if your skin infection is improving.

Most people make a full recovery after 7–10 days. If your symptoms are improving, you can stop taking antibiotics at the end of the prescribed course. If you are unsure, talk o your doctor to see if you need another course of antibiotics.

Wound care

If you have a wound, it needs to be kept clean and covered with a dressing. Your wound should be checked every day. This may be by a nurse or an Accident and Medical centre team. They will change the dressing and check that the wound is healing.

If your nurse or doctor decides you don’t need to see them every day, they will tell you how to look after your wound at home. If there is anything of concern, ask your doctor what to do.

Note that cellulitis does not cause pus. If you have pus coming from the wound you should tell your doctor. There may be an abscess that needs to be drained for the infection to get better.

How can I care for my cellulitis?

As well as taking antibiotics, you can:

Get plenty of rest. This helps your body to fight the infection. If you have cellulitis on your the leg, minimise walking for the first few days.
Raise the affected body part on a pillow or chair when you're sitting or lying down. This helps reduce swelling. Continue to do this for the first 48 hours at least.
If your arm or hand is involved, use a sling when walking around. This not only helps relieve pain but also helps the healing process.
Drink plenty of fluids to prevent dehydration.

If you have diabetes or poor circulation you are at increased risk of cellulitis. It is important that you check your feet daily, moisturise your skin, trim your nails carefully and treat any infections on the skin (like athlete’s foot) quickly.

Cellulitis can be quite painful because it puts pressure on the skin from underneath. Your doctor will discuss appropriate pain relief and may give you a prescription.

What can I do to stop cellulitis recurring?

You can reduce the chances of getting cellulitis again by:

keeping skin clean and well moisturised – dry skin causes cracks which increase your risk of cellulitis
cleaning any cuts or wounds.
preventing cuts and scrapes by wearing protective clothing and footwear
keep finger nails short and avoid scratching
treating any breaks in your skin, eg, due to athlete’s foot or eczema
wearing gloves if working outside.

If you have had cellulitis more than once you might be prescribed low-dose long-term antibiotics to stop infections coming back.

Cellulitis complications

If not treated quickly, the infection can spread to other parts of the body, such as the blood, muscles and bones.

Call 111 or go to A&E now if you have cellulitis with:

a very high temperature or you feel hot and shivery
a fast heartbeat or fast breathing
purple patches on your skin
confusion, dizziness or disorientation
cold, clammy, pale skin
unresponsiveness or loss of consciousness

These are symptoms of sepsis, which can be very serious and potentially life-threatening.

Learn more

Cellulitis – skin deep and spreading across NZ BPAC, NZ, 2015
Antibiotics – choices for common infections – cellulitis BPAC NZ, 2017
Cellulitis Kidshealth, NZ
Cellulitis NHS Choices, UK
Cellulitis Mayo Clinic, US

Resources

Support

Phone Healthline for free on 0800 611 116 any time of the day or night for advice on any health issue, no matter how small. In an emergency, phone 111 for an ambulance.

Brochures

Cellulitis

Workbase Education Trust and Ministry of Health, NZ, 2013

Managing your cellulitus

Auckland DHB, NZ, 2017

Keeping skin healthy

Ministry of Health and Workbase, NZ

Information for healthcare providers on cellulitis

The content on this page will be of most use to clinicians, such as nurses, doctors, pharmacists, specialists and other healthcare providers.

Clinical guideline

The following information is taken from intravenous antibiotics for cellulitis Auckland Regional HealthPathways, accessed October 2019

Consider community IV antibiotics if patient meets criteria:
–No improvement or worsening of symptoms after 48 hours appropriate oral antibiotic treatment
–limb cellulitis not suitable for oral antibiotics
POAC will not fund intravenous (IV) antibiotics without a trial of oral antibiotics for a reason other than limb cellulitis not suitable for oral antibiotics unless they have been endorsed by an appropriate hospital specialist.
Seek infectious diseases advice, or in Auckland DHB, contact the cellulitis clinical nurse specialist, if concerned, and considering starting intravenous (IV) antibiotics without a trial of oral antibiotics in patients who do not meet the above criteria.
Use IV cefazolin, with oral probenicid if appropriate. Oral antibiotics are not usually indicated while IV antibiotics are being given.
Refer patient to POAC or treat under ACC.
Calculate the dose of IV cefazolin:
–If normal renal function and aged < 65 years.
–If renal function unknown and aged < 65 years.
–If impaired renal function or aged ≥ 65 years.
–If penicillin or cephalosporin allergy.
Use probenecid if appropriate. Do not prescribe probenecid to elite athletes as this is on the prohibited list from the World Anti-Doping Agency.
–No renal impairment
–Renal function unknown and aged < 65 years
–If the impaired renal function or aged ≥ 65 years, follow the table.
Give patient information and emphasise the need for rest, good hydration, and limb elevation.
Review daily.
–If showing improvement after 48 hours, switch to oral therapy. Start oral antibiotics 24 hours after the last dose of IV cefazolin.
–If no improvement or cellulitis is worse, seek advice according to patient's DHB of residence.

Clinical management

The following advice is from Antibiotics – choices for common infections – cellulitis BPAC, NZ, 2017

Antibiotic treatment is required for all patients with cellulitis.

Oral antibiotic treatment is appropriate for those with mild to moderate cellulitis.
Refer for IV antibiotics if any of the following:

under one year of age
cellulitis is extensive
near the eye
surrounds a limb
over a joint, or
not responding to oral antibiotics
systemic symptoms are present (e.g. fever, nausea, vomiting).

Also check if pain relief is needed.
Encourage patient to rest and keep affected area or limb elevated if possible.

Antibiotic treatment

First choice

Flucloxacillin

Child: 12.5 – 25 mg/kg/dose, 4 times daily, for 5 days
Adult: 500 mg, 4 times daily, for 5 days

Alternatives

Cefalexin (if flucloxacillin not tolerated)

Child: 12.5 mg/kg/dose, 4 times daily, for 5 days (maximum 500 mg/dose)
Adult: 500 mg, 4 times daily, for 5 days

Erythromycin (if allergy to flucloxacillin or MRSA present)

Child aged < 12 years: 20 mg/kg/dose, twice daily, or 10 mg/kg/dose, 4 times daily, for 5 days (maximum 1 g/day)
Adult: 800 mg, twice daily, or 400 mg, 4 times daily, for 5 days

Trimethoprim + sulphamethoxazole (if allergy to flucloxacillin or MRSA present)

Child > 6 weeks: 24 mg/kg/dose, twice daily, for 5 to 7 days (maximum 960 mg/dose)
Child > 12 years and Adult: 960 mg (two tablets), twice daily, for 5 to 7 days

Regional HealthPathways NZ

Access to the following regional pathways is localised for each region and access is limited to health providers. If you do not know the login details, contact your DHB or PHO for more information: