When Should You Worry About Cellulitis? 5 Reasons to Go to the ER for Treatment

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Cellulitis refers to any skin infection. Cellulitis can be caused by many different types of bacteria, and it can happen in any part of the body. It's a fairly common infection, with an estimated 14 million cases a year.

Most of the time, the infection clears up with a round of oral antibiotics (taken by mouth). But a small percentage of cases - fewer than 0.5% - are more complicated and may require intravenous (IV) antibiotics or hospitalization.

But how do you know if your infection falls into this category? Let's go through common symptoms of cellulitis, risk factors, and warning signs of an emergency.

What are common symptoms of cellulitis?

Early cellulitis symptoms are usually mild. They may include:

• Red, violet, or brown skin patch

• Small divots in the skin (like an orange peel)

• Swelling or blisters

• Painful or tender skin

• Skin that feels warm

• Fever

• Chills

Severe cellulitis

Sometimes symptoms of cellulitis can turn severe. You should seek emergency care for cellulitis if you experience any of these symptoms:

• Worsening fever

• Weakness

• Muscle aches or pains

• Skin discoloration that's spreading

• Discolored lines that run outward from the main rash

• Abscess (a pocket of bacteria and pus)

• Numbness or tingling in the affected area

• Patches of blackened skin

Close-up of cellulitis on a hand with an abscess.

When should you go to the emergency room for cellulitis?

Usually cellulitis can be successfully treated at home with oral antibiotics (pills). But sometimes, things can get worse instead of better. And in other cases, you'll need intravenous (IV) antibiotics from the hospital immediately. Here's when you'll need to get emergency medical attention for cellulitis.

1. Your infection isn't getting better with antibiotics

You should see improvement in your cellulitis symptoms within 24 to 48 hours after starting oral antibiotics. Check the infection regularly, and look for signs of improvement, including:

• Less redness: After you start antibiotics, it may take a day or two to see redness go down. But, at a minimum, the redness shouldn't get worse. A good way to tell is to draw a line around the red area before you start antibiotics.

• Less pain: The infected area will feel less tender.

• Less fever: If you have a fever, it should start to go away.

If you're taking oral antibiotics for cellulitis and it's not getting better, then you may have a more complicated case of cellulitis. If your cellulitis isn't improving after 48 hours on antibiotics, you may need a change in the type of antibiotic you're taking or an IV form of the same antibiotic.

2. The cellulitis is in a high-risk location of your body

In certain areas of the body, it's more common for an infection to spread faster or deeper. Or, the infection is more likely to cause complications to nearby body parts.

If you have cellulitis in a high-risk area, you shouldn't delay getting urgent medical care. It's still possible to treat many of these infections at home with oral antibiotics. But, if you have an infection in one of these areas, get re-evaluated right away if your symptoms aren't getting better.

High-risk locations for cellulitis include:

• Eyes: If you have an infection near your eye, it's a little more concerning because bacteria can spread more easily to your eye. In severe cases, this can lead to vision loss or even infection or blood clots in the brain.

• Neck: Cellulitis in and around your neck can become a problem when the swelling starts to push on your airway.

• Joint: Sometimes what looks like a skin infection over a joint is actually an infection inside the joint. This requires special treatment to avoid permanent damage to the joint. This kind of infection will be relatively obvious because it'll cause severe pain inside the joint any time you move.

• Hand: Infections here can spread quickly because of the tight spaces in your hand. And severe infection can permanently damage important structures that can affect hand function.

• Perineum: This is the area between the genitals and anus. These infections are particularly dangerous because they spread deep and fast. This can quickly lead to sepsis (discussed below).

The good news is that most cases of cellulitis start in lower-risk locations, like arms and legs. But that doesn't mean these infections are completely risk-free. It becomes concerning when the infection goes around the entire limb. If you notice redness that goes all the way around your arm or leg and you have severe pain, you may need more aggressive treatment to get the infection under control.

3. The cellulitis may be caused by an unusual bacteria

Most cases of cellulitis are caused by the bacteria that naturally live on the surface of our skin, like Staphylococcus aureus and Streptococcus pyogenes. But sometimes, cellulitis is caused by a less-common bacteria. This means that it may not respond to typical antibiotics, and you might need a different type of antibiotic.

There are certain situations that make it more likely your skin infection could be caused by a different bacteria:

• Animal bites: Cat, dog, or even human bites tend to introduce different germs into the skin. So, cellulitis that starts with a bite needs a different antibiotic.

• Water exposure: Lakes, rivers, pools, and hot tubs contain different types of bacteria. So, if you got a cut while underwater, or if you exposed a cut to bath water right after it happened, bacteria from water may be the culprit.

• Foreign body: Sometimes, cellulitis starts with an injury from an object, such as a splinter. Often these objects are dirty and lined with bacteria. This might mean that the object needs to be removed (if it's still under your skin), and it may mean that you'll need a different type of antibiotic.

You may also be wondering about the methicillin-resistant Staphylococcus aureus (MRSA)infection. This type of cellulitis is resistant to some antibiotics. But it can be hard to know if this bacteria is the one causing your infection.

You're at higher risk of having cellulitis from MRSA if you:

• Share a locker room with others (like athletes)

• Live in a long-term care facility

• Have been in close contact with someone (such as a family member) with MRSA

• Have been hospitalized recently

• Have had surgery recently

4. You have other medical conditions that put you at increased risk of complications

Certain medical conditions can make it harder to treat cellulitis. This can be because of decreased blood flow to the area, a weakened immune system, or another reason. Some of these conditions include:

• Edema: Swelling of the lower legs, called edema, can decrease blood flow to these areas. So, if the infection is located in this area, it may make it harder for immune cells or antibiotics to reach it.

• Peripheral artery disease: Similar to edema, peripheral artery disease can affect blood flow to the area that has cellulitis.

• Diabetes: High blood sugars can make it easier for bacteria to grow. In addition, people with diabetes can have poor blood flow to their arms and legs, similar to the above conditions. Over time, this can also cause damage to nerves that decreases their ability to sense small injuries or pressure ulcers. And these can become an entry point for bacteria.

• Being immunocompromised: Any condition or medication that weakens your immune system and causes you to be immunocompromised makes it harder for your body to fight off infections.

5. The infection has gotten into your bloodstream

Sometimes, the bacteria that causes cellulitis can find its way into your bloodstream. This is called bacteremia.

When this happens, the infection can start to take a toll on your other organs. This is called sepsis, and it can be life threatening.

If you start to develop bacteremia or sepsis, you will most likely begin to feel more unwell. In addition to your cellulitis rash, you will also probably develop new symptoms:

• Fever and/or chills

• Vomiting

• Dizziness (a sign of low blood pressure)

• Fast heart rate

• Breathing fast or feeling short of breath

• Confusion or disorientation

• Generalized weakness or lethargy (trouble staying awake)

• Clammy skin that's pale or dusky

Frequently asked questions

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