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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
• Prognosis and Possible Complications
• Following Up
• Supporting Research

Cellulitis is an inflammation of the skin, caused by a bacterial infection. It can also affect the connective tissue beneath your skin and, in severe cases, spread to your lymph nodes. 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. Without treatment, it can become life-threatening.

Signs and Symptoms

Cellulitis is accompanied by the following signs and symptoms:

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

What Causes It?

Cellulitis is caused by bacterial, most often by streptococcus or Staphylococcus aureus, that enter the body through a break in the skin. In 50 - 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, the 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:

• Age
• General weight loss and weakness, especially from chronic illness
• Diabetes
• Chickenpox and shingles
• Lymphedema (swelling of arms or legs)
• Fungal infections of the feet
• Peripheral vascular disease
• Contaminated wounds
• A weakened immune system
• A general infection

What to Expect at Your Provider's Office

If you experience symptoms associated with cellulitis, you should see your health care provider as soon as possible. Your health care provider 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. It is important to elevate the affected arms or legs, to keep still, and to apply cool, wet, sterile bandages to relieve discomfort. If your symptoms aren't better after 1 or 2 days, you may need hospitalization so doctors can administer antibiotics intravenously.

Drug Therapies

Your health care 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

It is important to get conventional medical treatment for cellulitis and, because it can spread rapidly, to start antibiotics as soon as possible. This may prevent complications from the skin and soft tissue infection. Most alternative therapies have not yet been studied for use specifically in cellulitis. Several therapies, though, may reduce the risk of developing cellulitis or ease some of the symptoms when used in conjunction with conventional care. You should never treat cellulitis with alternative therapies alone.

Nutrition

The following supplements may strengthen the immune system and help skin heal:

• Vitamin C (1,000 mg two to six times per day in adults for short periods)
• Vitamin E (400 - 800 IU per day)
• Zinc (30 mg per day)

Bromelain (250 mg two to three times per day), taken between meals, reduces inflammation. It is often used with turmeric ( Curcuma longa ), an anti-inflammatory that makes the effects of bromelain stronger.

Researchers have not studied the ways specific nutrients may affect cellulitis. However, 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 the risk of cellulitis. Quercetin (up to 1,000 mg two or three times per day) is a flavonoid available as a supplement.

Herbs

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

Taken orally:

• Echinacea ( Echinacea spp., 500 - 1,000 mg three times per day) is used to strengthen the immune system. It may also be used topically as a gel or cream containing 15% juice of the herb for treatment of inflammatory skin conditions.
• Pycnogenol ( Pinus pinaster, 200 mg per day), an extract of the bark of a particular type of pine tree, helps promote skin health.
• Thyme ( Thymus vlugaris , 1 - 2 g per day in divided doses). Do not take thyme with blood-thinning medication, and never take oil of thyme, which can be toxic.
• Gotu kola ( Centella asiatica , 60 mg two times per day) helps improve skin health as it can have a stimulating effect. Do not take gotu kola if you experience anxiety or have high blood pressure.

Applied topically:

• Yarrow ( Achillea millefolium) is approved in Great Britain for skin infections and inflammation. It is applied topically. Use 100 g per five gallons of warm or hot water for a sitz bath.
• Goldenseal root ( Hydrastis canadensis ), which has both anti-inflammatory and antibacterial properties, and slippery elm ( Ulmus fulva), an antiseptic, may be made into a paste and placed on the affected area two times per day.
• Calendula flower ( Calendula officinalis) is approved in Germany for topical application to leg ulcers (open wounds of the leg that can readily become infected). Make a tea by adding one to two teaspoons dried flowers to one cup boiling water and steeping for 5 - 10 minutes. Let cool, then soak a clean, soft cloth with the solution and apply to affected area.
• Fenugreek seed ( Trigonella foenum-graecum ), which contains flavonoids, is approved in Germany for external use on skin inflammation and infections. Mix 50 g of powdered fenugreek seed with one quart of hot water and let stand until it forms a thick paste. Apply to a clean, soft cloth and place on the affected area.

Homeopathy

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 -- your 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. It may be used for children. Cahtaris is 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. The practitioner should take caution when piercing the skin that may be infected, because there is a risk of spreading the infection further. Talk to your doctor first and use a qualified acupuncturist experienced in treating infectious skin disease.

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 and 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 health care provider should see you periodically to make sure you have no complications.

Supporting Research

Belcaro G, Cesarone MR, Errichi BM, et al. Diabetic ulcers: microcirculatory improvement and faster healing with pycnogenol. Clin Appl Thromb Hemost . 2006 Jul;12(3):318-23.

Biswas TK, Mukherjee B. Plant medicines of Indian origin for wound healing activity: a review. Int J Low Extrem Wounds. 2003 Mar;2(1):25-3

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. 3 ^rd ed. New York, NY: Penguin Putnam; 1997:320, 331-335, 341, 345.

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.

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..

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

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: 10/23/2006
• Reviewed By: Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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