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Cellulitis Signs Symptoms and Diagnosis

By Valencia HigueraMedically Reviewed by Ross Radusky, MDReviewed: August 21, 2018Medically ReviewedIn more severe cases of cellulitis, blisters may form and skin may break down.Stephanie Starr/AlamyCellulitis is a potentially serious bacterial skin infection that is most commonly caused by the Staphylococcus (staph) or Streptococcus (strep) bacteria, although other types of bacteria can also cause it. Symptoms of cellulitis can start suddenly, with an area of skin rapidly going from normal looking to red and swollen. (1) Antibiotics are needed to treat cellulitis. Because the infection can worsen quickly, possibly spreading to the lymph nodes and bloodstream, it’s important to seek medical help if you develop signs and symptoms of cellulitis. Here’s what you need to know if you suspect that you might have cellulitis.

Common Signs and Symptoms of Cellulitis

“The most common site for cellulitis to occur is on the lower legs, although cellulitis can occur on any area on the body,” says Anna Guanche, MD, a board-certified dermatologist and beauty expert in Calabasas, California. When cellulitis develops in a leg or foot, it often occurs on only one side of the body. (1) In children, cellulitis is most likely to occur on the face and neck. Other areas that may be affected include the eyelids, arms, and hands. (1) Common signs and symptoms of cellulitis include the following: (1,2,3) Redness Redness caused by cellulitis may start in one area then spread to cover a larger area. It can sometimes be difficult to tell where the redness ends and normal-looking skin begins, according to the American Academy of Dermatology. (4) Warmth Skin warmth caused by cellulitis isn’t always apparent until a person touches or presses on the affected area with a finger or hand. (4) Pain and Tenderness Cellulitis triggers inflammation, which leads to pain and tenderness. Pain can be moderate or severe, depending on the severity of the infection. Pain is sometimes triggered by pressing on the affected skin. Swelling Swelling caused by cellulitis may start in one area and gradually spread. Some people also develop swollen lymph nodes near the site of an infection. (1)

Signs and Symptoms of Severe Infection

Additional symptoms may occur when the infection becomes severe. “In more severe cases, additional clinical features may include blister formation, pustules, and necrosis (skin breakdown),” says Tsippora Shainhouse, MD, a board-certified dermatologist in Long Beach, California, and a clinical instructor at the University of Southern California. A person may also develop cold sweats, fever, and difficulty concentrating. A severe infection can give rise to a rapid heart rate — more than 100 beats per minute while at rest — and low blood pressure. (4,5) If left untreated, rapid heartbeat can affect heart function and increase the risk of major complications such as heart failure, cardiac arrest, and stroke. A low blood pressure level, generally defined as a blood pressure reading lower than 90 millimeters of mercury (mm Hg) systolic or lower than 60 mm Hg diastolic, can be dangerous, too. (6) Also called hypotension, low blood pressure can cause dizziness, blurry vision, nausea, and lack of concentration. Untreated cellulitis can spread to muscles, bones, the heart, the nervous system, and the bloodstream. The latter puts you at risk for sepsis. (3,7) Cellulitis that advances to sepsis is a medical emergency and life-threatening. Signs of this condition include a high fever, a fast heartbeat, fast breathing, clammy skin, disorientation, and loss of consciousness. (8)

Diagnosing and Treating Cellulitis

If you develop signs or symptoms of cellulitis, seek medical help quickly, either from your own doctor or in an emergency department or urgent-care center. In most cases you won’t need a diagnostic test. (9) According to Dr. Guanche, most doctors are able to diagnose this condition by looking at your skin. A broad-spectrum antibiotic, which is effective against different types of bacteria, may be prescribed for cellulitis. (9) Your doctor may examine the skin to pinpoint where the bacteria entered your body. “Occasionally, it’s a surgical site, but it can also be from an insect bite or from a scrape of any kind — anything that introduces bacteria into the skin,” says Guanche. You should start to feel better within about three days of starting antibiotics, although you’ll need to take your prescribed antibiotics for 10 to 14 days, or else risk a recurrence of the infection. (9) Your doctor may schedule a follow-up appointment to check your progress. Further testing is needed if your symptoms don’t improve or if they worsen. Guanche notes that in some situations, doctors may perform a bacterial culture and sensitivity test on any pus to determine which strain of bacteria is causing the cellulitis so that targeted antibiotic therapy can be prescribed. “A doctor may order blood work to look at a patient’s white blood count or blood cultures to make sure the cellulitis has not spread to the bloodstream, causing sepsis,” she says. (9,10) Sometimes, doctors perform a skin biopsy, in which a small amount of skin is removed and sent to a laboratory for examination. This procedure can help confirm a diagnosis by ruling out other skin abnormalities. (7) If you have a skin biopsy, you can expect some pain or tenderness for a few days after the procedure. If your cellulitis doesn’t clear up with oral antibiotics, your doctor may admit you to the hospital so you can receive antibiotics intravenously. (10) Intravenous therapy allows the medicine to get into your system faster. This type of therapy is necessary for infections that spread to the bloodstream. When a person has recurring episodes of cellulitis, a doctor may prescribe a low-dose antibiotic to prevent future infections. (11)

When to See a Doctor for Skin Symptoms

Knowing when to see a doctor for skin changes is sometimes tricky, but according to Barbara Bergin, MD, a board-certified orthopedic surgeon at Texas Orthopedics, Sports & Rehabilitation Associates in Austin, Texas, “If a rash is mild and not associated with a severe systemic allergic reaction, it might not be necessary to seek a consultation with your doctor, and you can perhaps wait a little while to see if it resolves spontaneously.” On the other hand, Dr. Bergin warns that if you suddenly develop a rash that spreads or is associated with other symptoms, such as a fever, chills, or just a bad feeling overall, it would be wise to call your primary-care physician or head to the emergency department. Some skin injuries may also require a doctor’s care. “Any laceration that penetrates deeper than the very superficial layer, called the epidermis, is likely to require disinfection and perhaps a stitch, application of butterfly bandages, or superglue,” says Bergin. “Otherwise, one risks infection and delayed healing, and there certainly would be a greater likelihood of an unsightly scar,” she says. It’s a good idea to see a doctor if you or your child are bitten by an animal or another human. Your doctor can provide practical instructions on the best way to care for these wounds and prevent complications.

Healing From Cellulitis

If you’re diagnosed with cellulitis, your doctor can offer tips to help you feel more comfortable as you wait for your condition to improve. For one thing, swelling due to cellulitis can be uncomfortable, so you might be instructed to keep your leg or foot elevated to reduce swelling. Your doctor may say it’s okay to take an over-the-counter pain reliever, such as Tylenol (aceteminophen), Motrin (ibuprofen), or Aleve (naproxen), along with your antibiotic. (9) When cellulitis occurs as a complication of another skin condition, your doctor may come up with a treatment plan to eliminate the underlying cause. This might be the case if the cellulitis appears to stem from breaks in the skin caused by athlete’s foot or eczema. Taking care of the underlying problem can help prevent recurrence. NEWSLETTERS

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Editorial Sources and Fact-Checking

Cellulitis: Symptoms and Causes. Mayo Clinic. April 10, 2018.Cellulitis: Overview. American Academy of Dermatology.Cellulitis. Kids Health. October 2013.Cellulitis: Signs and Symptoms. American Academy of Dermatology.Tachycardia: Fast Heart Rate. American Heart Association. September 30, 2016.Low Blood Pressure (Hypotension): Symptoms and Causes. Mayo Clinic. March 10, 2018.Cellulitis. John Hopkins Medicine.Symptoms. Sepsis Alliance.Cellulitis: Diagnosis and Treatment. Mayo Clinic. April 10, 2018.Cellulitis: Diagnosis, Treatment, and Outcome. American Academy of Dermatology.Cellulitis: How to Prevent It From Returning. American Academy of Dermatology.Show Less

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