Emergency and Urgent Care - Cellulitis

Cellulitis is an infection of the deeper layers of the skin and the underlying tissue.

The main symptom of cellulitis is the affected area of skin suddenly turning red, painful swollen and hot. It most often affects the legs but can occur anywhere on the body.

Causes

Cellulitis can have a wide range of causes, but the majority of cases are due to an infection caused by the streptococcal or staphylococcal groups of bacteria. In rarer cases, it may be caused by a fungal infection.

Cellulitis develops when bacteria or fungi move down through the skin’s surface through a damaged or broken area of skin, such as a cut, burn or bite. Having a skin condition such as eczema or a fungal infection of the foot or toenails (athlete’s foot) can cause small breaks and cracks to develop in the surface of the skin. This makes a person more vulnerable to cellulitis.

Who is at risk?

A number of health conditions can increase your risk of developing cellulitis. These include:

• Being obese (excessively overweight)
• Having a weakened immune system
• Having poorly controlled diabetes
• Having circulation problems
• Having chickenpox or shingles
• Having lymphoedema (a condition that causes swelling of the arms and legs)
• Having long-term untreated athlete’s foot or a fungal toenail infection
• Intravenous (IV) drug use
• Having previous episodes of cellulitis
• Have a surgical wound
• Have a pressure sore (bed sores)

Preventing cellulitis

Not all cases of cellulitis can be prevented. But you can reduce the risk of developing the condition by taking steps to prevent skin wounds and treating wounds properly when they occur.

Treating cellulitis

Treatment for cellulitis depends on what caused the infection, the severity of your symptoms and the general state of your health. You can usually be treated at home with antibiotics if you have mild symptoms.

Antibiotics

The length of the course will depend on your circumstances, including how quickly you respond to treatment and whether you have any underlying conditions such as lymphoedema.

The most commonly prescribed antibiotic for cellulitis is flucloxacillin, which is part of the penicillin group of antibiotics. The most common side effects of flucloxacillin are mild digestive problems, such as an upset stomach or episodes of diarrhoea.

If you cannot take flucloxacillin because you’re allergic to penicillin, alternative antibiotics such as erythromycin or clarithromycin can be used.

If it’s suspected that your cellulitis was caused by a wound being exposed to contaminated water, you will be given a combination of two different antibiotics. This is usually doxycycline or ciprofloxacin in combination with flucloxacillin or erythromycin.

When you first start taking the antibiotics, you may notice that your skin becomes redder. This is usually only a temporary reaction, and the redness should start to fade within 48 hours. The area of redness should have been marked with a skin marker in the Urgent Care Centre before you were discharged.

Self-care

There are steps you can take at home to ease your symptoms and speed your recovery from cellulitis:

• Drink plenty of fluids to avoid dehydration
• You can take painkillers such as paracetamol or ibuprofen for the pain
• If your leg is affected by cellulitis, keep it raised whilst you are resting, using pillows or a chair. This should make you feel more comfortable and help to reduce the swelling. If possible, the foot should be raised higher than the hip. If your arm is affected, try and keep your lower arm raised above your elbow
• If it’s uncomfortable to raise the limb, try to lie down as much as possible. However, it’s important to still regularly move the joints, such as your wrists or ankles
• Try to avoid cuts and grazes from activities that increase the risk. For example, by wearing clothing that covers your arms or legs when gardening
• Do not wear compression stockings until your cellulitis has resolved

You can also take steps to help prevent cellulitis from reoccurring:

• Maintaining good hand hygiene
• Keeping your skin moisturised
• Treating cuts and grazes or any broken skin caused by a condition such as eczema
• Treating fungal infections of the hands or feet, such as athlete’s foot

Preventing recurrent cellulitis

People who experience frequently recurring cellulitis, such as those with lymphoedema, may be recommended to begin taking antibiotics on a long-term basis to protect against further infection. Long-term antibiotics may be prescribed if you experience recurrent cellulitis (more than two episodes a year in the same area).

Worsening signs and symptoms

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

If you develop any of the following symptoms then you must return to the Urgent Care Centre, attend an Emergency Department for further assessment and treatment:

• Redness that has spread significantly outside of the marked area
• Red line moving up from affected area towards centre of body (i.e. towards the heart)
• Painful lumps to groin, armpit or neck

If you develop any of the following sign’s ring 999 or attend an Emergency Department as these are signs of Sepsis which can be very serious and potentially life threatening:

• Feeling feverish (high temperature), hot and shivering
• Fast heartbeat or breathing
• Purple patches to skin
• Feeling dizzy or faint
• Cold, pale, clammy skin
• Confusion or disorientation
• Drowsiness, unresponsiveness or loss of consciousness

Who to contact if you are concerned

If you have any concerns about your symptoms, you should contact your GP or call 111 for advice, or you can contact Rochdale Urgent Treatment Centre – 01706 517023.

Useful links

NHS Choices www.nhs.uk/conditions/Cellulitis/Pages/ Introduction.aspx

Work

If you do not feel capable of working either due to pain or reduced movement/mobility, you are able to self-certify sickness for the first 7 days.

You must complete a self-certification form found on the government website and give this to your employer. This entitles you to statutory sick pay from your employer for up to 7 days.

To access the self-certification form, follow this link:
https://www.gov.uk/government/publications/statutory-sickpay- employees-statement-of-sickness-sc2

If you feel you need longer than 7 days off work, you must contact your GP for a sick note. The Urgent Treatment Centre does not issue sick notes.