You wake up, and your leg hurts. In fact, it’s downright painful. Upon examination, you notice your entire lower leg is swollen and tender. It’s unlike anything you’ve ever seen.
“What is this?” you think. “Am I allergic to something?”
Your skin looks tight and shiny. And upon touch, it’s blazing hot. You feel a little feverish -- as if you have the flu. You’re tired, too. Maybe you need to lie down. Thinking this bout of whatever it is will go away on its own, you opt not to go to the doctor. A simple nap will do. These things always clear up naturally, right?
In a couple of days, the mystery affliction has gotten worse. Your leg is more swollen and hurts more than ever. A spot that looks like a boil is in the center of the swelling. In addition, there is pus coming out. It’s what can only be described as gross. Scared, you schedule an appointment with your doctor, who, after a routine examination, diagnoses you with a condition you’ve never heard of. It sounds like cellulite, but that’s not it. “You have cellulitis,” she states. “And this is nothing to take lightly. You’ll need medications.”
“What the heck is that?” you wonder.
If you’ve never heard of cellulitis, you’re definitely not alone. Most people haven’t.
According to the Mayo Clinic, “Cellulitis is a common, potentially serious bacterial skin infection.” Though it isn’t possible to spread cellulitis to others, it can spread quickly to other parts of the body.
“Cellulitis, to simply put it, is an infection of the skin,” says Dr. Andrew Petelin, an infectious disease specialist at Mount Sinai Hospital in New York. “The bacteria that cause it enter through cracks or breaks in the skin -- sometimes which are so small that they may not be visible to the eye. More commonly, however, there is a preceding cut or wound that becomes infected, which can then additionally cause infection of the surrounding skin. Usually this happens if the wound is not kept clean or is scratched. If there is a boil, people sometimes think the right thing to do is break it open themselves and squeeze out the pus. By doing this, they are potentially introducing even more bacteria into the wound.”
According to Healthline, common skin injuries like wounds, bites and surgical incision sites cause about 50 to 60 percent of cellulitis cases. And though anyone can get cellulitis, there are some high-risk groups.
“It’s more common with people who have other underlying conditions like diabetes, peripheral vascular disease or those who take immunosuppressive drugs (e.g., transplant patients, those with certain autoimmune conditions, severe skin conditions, or inflammatory bowel diseases),” Petelin says. “Cancer patients who are actively undergoing chemotherapy or HIV patients are at higher risk as well.”
Petelin says people who are obese seem to get cellulitis more often than people who are normal weight. Further, studies show that extreme obesity may affect treatment outcomes in relation to the condition. In fact, obesity may double the rate of adverse reactions.
So just what are the signs of cellulitis? The first two telltale signs are redness and temperature.
“There is a bright red, fiery color to the skin,” Petelin says. “It’s hot and painful when you touch it. In addition, if there is a wound or boil, a pus-like discharge near the area is usually seen.”
Further, swelling can occur. This is a common symptom. “It’s seen most commonly in the legs but can happen anywhere in the body,” Petelin notes. Fever can be another indication. However, this is not always the case. “People don’t always have fever, but it is relatively common,” Petelin says.
Other symptoms include chills, malaise or a feeling of just plain being sick, tiredness, sore muscles and sweating. Diagnosing the exact cause of cellulitis can be complex. That’s because more than one type of bacteria can create this condition.
“The two most common types of bacteria that cause it are streptococcus and staphylococcus,” Petelin says. “There are two types of staphylococci. One is regular staphylococcus (MSSA) and the other is resistant staphylococcus (MRSA).”
People often wonder if these differing types of bacteria give a different appearance. The answer is yes. And at times, there can be a rather gruesome difference between the two.
“Staph are typically the ones that have pus. In severe cases, they can turn into a deep abscess, which looks like a big red ball under the skin. These are encased with pus that is not draining externally. Abscesses often need to be drained open since antibiotics alone are sometimes not enough to treat, especially if they are deep,” Petelin says. “Strep has the same appearance as staph, but it is the one that has more of a shiny appearance to it and usually does not have boils or pus-like discharge.”
That said, cellulitis can sometimes look like a minor rash. Consequently, you might not know you have it at all.
And you can get it again if you’ve already had it. However, recurrences are most common in high-risk groups.
“People that are prone to infections are the same groups mentioned earlier and include diabetics, those with peripheral vascular disease and those that are immunocompromised,” Petelin says.
The good news is that modern medications are very effective in battling the condition. Different types of antibiotics are used, depending upon the cause.
“The one with the bad reputation is MRSA, but there are several antibiotics that treat it effectively,” Petelin says. “One is Bactrim, which is a sulfa drug, so if the patient is allergic to any type of sulfa drug, they should not take it.”
“Other options, which are equally effective, are Minocycline, which is a Tetracycline derivative, and Clindamycin,” says Petelin. “Clindamycin is good if you can’t tell whether you are dealing with a strep infection or a staph infection because there can be some overlap between the two. Clindamycin is good in that it will work for strep, MSSA and MRSA.”
That said, Clindamycin can have a rather bothersome side effect in some cases.
“It can cause an infection in the stool called C. difficile, so you always have to tell patients to let their doctor know if they develop large amounts of watery diarrhea,” Petelin adds.
For MSSA and strep, there is yet another option. However, this option will not treat MRSA.
“The most common antibiotic used for MSSA and strep is Keflex,” says Petelin. “It is a cephalosporin, which is a branch of the penicillin drugs. It can generally still be used if the patient is allergic to penicillin, but if the reaction is something severe like anaphylaxis, it should not be used. The alternative here is Levaquin, which is a quinolone drug and is in the same class as ciprofloxacin. So if the patient is allergic to ciprofloxacin, Levaquin should not be given. Quinolones will not treat MRSA.”
If you do suspect cellulitis, see your doctor immediately. The sooner you get treatment, the faster you’ll be back to yourself.