Cellulitis Of The Legs – Causes, Symptoms, And Treatment

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Cellulitis is a common bacterial skin infection that affects millions of people globally. It can be a painful condition that often requires antibiotic therapy and hospitalization.

Today I shall briefly discuss what cellulitis is and how it is managed.


Our skin acts as a barrier that keeps bacteria from getting into our bloodstream.

However, when there is a break in the skin, for any reason, these bacteria can enter the tissues underneath the skin causing infections. This infection is cellulitis.

Risk Factors For Cellulitis

Any condition where the skin is broken down, such as injuries, surgeries, insect bites, animal bites, etc., can increase the chance of developing cellulitis.

Patients who have diabetes, poor circulation, or lymphatic disease are also at higher risk of developing cellulitis.

Patients with diabetes usually have weak peripheral nerves, a condition called diabetic neuropathy. This reduces pain sensation in the feet. When an injury to the foot is sustained, patients do not realize this due to lack of pain. The wound ends up getting infected, leading to cellulitis.

The most common patient group affected by this condition is middle-aged and older adults. Men and women can be equally affected.

Bacteria Causing Cellulitis

Group A beta-hemolytic Streptococcus (Streptococcus pyogenes) is the most common bacteria that cause cellulitis. Numerous other bacteria have also been noted to cause this infection, with Methicillin Resistant Staphylococcus aureus being the second most common.

When this bacteria enters the bloodstream, it releases a number of toxins that can cause tissue damage and pain. If the bacteria grows unhindered without anything to stop it, these toxins can effectively damage all the vital organs in the body leading to a critical illness.

It is therefore important to manage cellulitis quickly and swiftly.

Symptoms And Signs Of Cellulitis

As you can see in the picture below, cellulitis makes the skin red and inflamed. The area is warm to the touch, and there can be swelling and pain when pressed upon.

cellulitis of the leg infection

Associated with this can be fever, chills, tiredness, and a lack of energy.

Fever can increase to over 102 degrees F sometimes in severe cases. Many patients have difficulty walking and come to the clinic in a wheelchair.

Diagnosis Of Cellulitis

The diagnosis of cellulitis is primarily clinical. When you go to the doctor, an exam will show most of the things I’ve talked about so far.

Most people with cellulitis only get it on one limb, and it usually happens on the lower limbs. If you have diabetes, your doctor may examine the spaces in between your toes to see if any cracks have developed that have been a portal of entry for bacteria.

Cracked heels are also a problem and allow bacteria to enter the skin. Fungal infections of the foot can also cause cellulitis.

In more advanced cases, small swellings that are filled with fluid (called vesicles) develop over the skin. These can rupture and release a clear yellow liquid.

While a diagnosis of cellulitis is primarily clinical, you will sometimes be asked to undergo certain blood investigations that can aid in the management of the condition.

This can include a complete blood count, a blood culture test, wound swab, and sometimes ultrasound scans of the affected area. Your blood sugar will be closely monitored as well.


Patients who have mild cellulitis without any worrying signs of infection can be treated with simple antibiotics. These are administered orally for a period of 5 to 7 days.

But for people with diabetes whose cellulitis is very bad, getting antibiotics through an IV in the hospital is often the best way to treat it. This is because antibiotics work faster in the affected area when they are injected directly into a vein.

In addition to antibiotics, patients who are critically ill and have low blood pressure may warrant admission to the intensive care unit. Intravenous fluids will be started along with the antibiotics, and close monitoring of not just blood pressure but also the patient’s vital organ function will be done.

There is always a risk that cellulitis will spread deeper into the body and necessitate surgical treatment in people with low immunity. Remember that cellulitis is an infection, and essentially the swelling contains pus. Removing this pus becomes paramount in order to relieve the infection.

In my work, I have often sent patients with cellulitis in their lower limbs to a plastic surgeon. The plastic surgeon will look at the skin carefully to see how healthy it is and may remove any dead skin that is on the surface.

If the skin over the cellulitis area starts to die and demonstrates necrosis, emergency debridement surgery may need to be performed. This is a surgical procedure where the dead tissue is removed to allow healthy tissue from underneath to grow.

It is rare for patients with cellulitis to require amputation. But if the infection is spreading quickly and affecting the person’s vital functions, surgery may be the only way to save their life.


If the bacterial overload from the cellulitis infection is very high, it can lead to a condition called bacteremia.

This is where the bacteria spread through the circulatory system of the body and attacks the other organs. For example, the bacteria from cellulitis of the leg can spread through the bloodstream all the way up to the heart leading to a condition called endocarditis, which can be serious and critical.

There are certain warning signs the doctors look for when treating patients with cellulitis. Patients who have a fever of over 100.4°F, increased breathing rate, increased heart rate, and a very high total white cell count have a condition called Systemic Inflammatory Response Syndrome (also called SIRS) which is a serious form of infection.


If treated early, cellulitis improves rapidly and patients recover very well. Most patients demonstrate an improvement within 48 to 72 hours.

Unfortunately, cellulitis can recover in about 8 to 20% of patients, and in some patients, the recurrence rate can be as high as 50%. Patients who have diabetes are particularly at risk.

If you have suffered from cellulitis, your doctor will tell you to maintain skin hygiene and to manage your overall health in a more efficient manner. Those with diabetes should follow their diet and lifestyle strategies Strictly.

Closing Remarks

Cellulitis is a common skin infection that affects patients with diabetes and those who have low immunity. Prompt treatment can resolve the condition within 48 to 72 hours. The most important things to do to prevent this condition are to keep your hands and feet clean and keep your blood sugar levels stable.

Dr Vivek Baliga B
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