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A Patient's Guide to Recurrent Cellulitis

Published on Mar 04, 2019   -  3 min read

Abstract

If you have recurrent cellulitis, here are some strategies to reduce your risk of infection.

A Patient's Guide to Recurrent Cellulitis

1) Chronic Leg Swelling:

Venous insufficiency, lymphedema, congestive heart failure, liver disease, and kidney disease are all causes of chronic leg swelling that predispose you to recurrent cellulitis. Have your doctor assess you for these medical conditions if you have recurrent cellulitis and leg swelling. Keep your legs elevated to minimize swelling. For venous insufficiency and lymphedema, compression stockings can be used to reduce the swelling of your legs. For swelling caused by heart, liver or kidney disease, you may require diuretics (water pills) to help your body eliminate excess salt and water to decrease swelling.

2) Fungal Infections:

Fungal skin infections such as athlete's foot can predispose you to recurrent cellulitis. These fungal infections provide a portal of entry for bacteria, most often streptococci and staphylococci, by causing cracks in the skin. Check your feet, especially between the toes, for cracks in the skin and a scaly rash. This might be athlete's foot. You need to clean your feet diligently every day and you may require a topical antifungal medication to treat the fungal infection. Fungus likes to grow in moist environments, so it is important to keep your feet free of excessive sweat and moisture.

3) Peripheral Arterial Disease:

If the blood flow to your legs is impaired, you are at higher risk of developing cellulitis. Your blood carries white blood cells and antibiotics to the site of infection. Without good blood flow, your body's immune system and medications cannot reach the affected area very well. You may require a CT scan to evaluate the blood flow and if the results are abnormal, you may need to see a vascular surgeon to discuss interventions to improve the blood flow. Ask your doctor to check the pulses on your feet to ensure they can be felt.

4) Obesity:

Obesity is associated with chronic leg swelling and serves as an indirect risk factor for cellulitis. Talk to your doctor about strategies to lose weight. This generally includes diet and exercise. Sometimes, medications or bariatric surgery are required if you are unable to lose weight with lifestyle modifications. Obesity is associated with many other medical problems as well such as diabetes, high cholesterol, heart disease, and stroke. It is strongly recommended to maintain a healthy weight to reduce your risk of developing other chronic diseases.

5) Prior Episode of Cellulitis:

If you had cellulitis previously, you are at risk of getting it again in the same area because the infection causes lymphatic scarring and impaired lymphatic drainage, which leads to lymphedema. The risk of infection increases with the number of prior episodes of cellulitis.

6) Chronic Skin Conditions:

If you have eczema, dermatitis or another skin problem, you are at higher risk of developing cellulitis because the skin is damaged by the underlying skin disease, or by scratching from itchiness. It is important to assess for any underlying skin disorder and ensure it is adequately treated to minimize your risk of infection. Sometimes, you may need to see a dermatologist for evaluation.

7) Antibiotic Prophylaxis:

Antibiotics can be used to treat and prevent cellulitis. If you get 3 to 4 episodes of cellulitis per year, then you may qualify for low dose Penicillin prophylaxis. By taking this medication every day, you minimize the risk of recurrent infection. Penicillin is not meant to be taken for many years or lifelong. It is meant to give you time to address any predisposing risk factor for cellulitis. Once those risk factors have been eliminated or controlled, then your doctor should take you off Penicillin and monitor you closely for any recurrent infection.

8) Cellulitis Mimickers:

There are some conditions that can mimic cellulitis such as venous insufficiency, blood clot, gout, and dermatitis. If your condition is not improving on antibiotics, then ask your doctor if the diagnosis is correct and if you are taking the right antibiotic. If the diagnosis is unclear or if the antibiotic is not working, then you should be referred to a dermatologist or infectious disease specialist. Do not keep taking different courses of antibiotics without a proper evaluation because of this only delays the diagnosis and proper treatment.

 

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Last reviewed at:
04 Mar 2019  -  3 min read

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