Cellulitis is a common, yet potentially serious, bacterial infection that affects the deeper layer of skin, called the dermis, and the fatty tissue underneath.
This infection primarily begins when bacteria, usually streptococcus or staphylococcus, enter the body through a break in the skin barrier, such as a cut, scratch, or insect bite.
Cellulitis can occur anywhere there is a skin breach on the body. It most often appears on the lower legs because it’s easier to get injured there and not notice, especially in people with diabetes, peripheral neuropathy, or various reasons.. The affected skin quickly becomes swollen, painful, warm to the touch, and discolored. If left untreated, the infection can spread to the bloodstream and cause severe complications like sepsis.
Doctors treat cellulitis with antibiotics to kill the bacteria and stop the infection from worsening. As such, the incidence of antibiotic-resistant bacteria like MRSA is increasing. Fortunately, certain cannabinoids, natural terpenes, and even endocannabinoids show promise in Petri dish studies against MRSA and various bacteria species both directly and indirectly by increasing susceptibility to established antibiotics.
Since we don’t have any clinical studies on cannabis and cellulitis yet, doctors must follow national and local antibiotic guidelines to treat probable bacterial infections and ensure safety.
The management of cellulitis covers immediate infection control and necessary measures to stop the infection from returning. To start, doctors must confirm the diagnosis, as many skin conditions look like cellulitis, and misdiagnosis leads to unnecessary antibiotic use.
The severity of the infection determines the location of care. For mild, uncomplicated cellulitis, treatment is provided outside of a hospital (outpatient), allowing the patient to remain at home.
When infections are severe or the patient is showing systemic symptoms (like high fever or signs of distress), the patient must be admitted to the hospital (inpatient). This is necessary because doctors administer stronger medication directly into the vein (intravenous or IV antibiotics) and monitor the patient closely.
Supportive care is also an essential part of management; patients are often advised to raise the affected limb above the level of the heart to reduce painful swelling, known as edema.
Importantly, management also involves a long-term strategy to prevent the high rate of recurrence: doctors must find and fix the conditions that damage the skin and allow bacteria to enter. This means managing chronic conditions like diabetes or vascular disease that increase skin breakage if left untreated. Any recreational (i.e. IV drugs), environmental (i.e. bathing in a contaminated water source), or workplace hazards (e.g., medical workplace, waste management) must also be considered and addressed for long-term success.
Cellulitis treatment primarily involves the use of appropriate antibiotics and supportive care. Doctors base the treatment plan on the infection’s severity and the likely bacteria causing it, typically streptococcus or staphylococcus. If severe, they will take a sample of the bacteria and send it to the lab to grow (blood culture) and determine the best antibiotics (susceptibility studies) to treat it with.
For mild, uncomplicated cases, doctors usually prescribe oral antibiotics like cephalexin or dicloxacillin. Current guidelines often recommend a shorter duration of 5 to 6 days for this treatment to reduce unnecessary antibiotic exposure. However, if the patient shows systemic signs (like high fever) or does not improve with oral medication, doctors must admit them to the hospital to run tests, give fluids, and administer intravenous (IV) antibiotics.
If the patient has risk factors for methicillin-resistant staphylococcus aureus (MRSA), the physician ensures the antibiotic choice, such as IV vancomycin, covers that resistant strain. Empiric antibiotics like these may be started until the blood cultures show susceptibility to a more specific and narrow antibiotic, to decrease antibiotic resistance-building.
Simultaneously, effective management requires supportive measures like fluids to aid recovery. Patients should also elevate the affected limb to reduce swelling, and they can use pain relievers for discomfort.
Also, doctors must identify and treat predisposing factors, such as athlete’s foot (a common fungal infection that causes cracked skin between the toes) or lymphedema (swelling caused by a blockage in the lymph system) because they break the skin barrier, letting bacteria in and causing the infection to come back repeatedly.
If cellulitis keeps returning frequently, doctors may start long-term, low-dose antibiotics to stop future episodes.
READ: Canadian Study Finds CBD Helps Diabetic Foot Ulcers
The diagnosis of cellulitis relies primarily on clinical examination — what the doctor sees and feels. Doctors look for the acute, spreading onset of erythema (redness or discoloration), warmth, swelling, and tenderness or pain in the affected area, often accompanied by general symptoms like fever.
An important step is the need for doctors to rule out conditions that mimic cellulitis, such as eczema, blood clots, or chronic swelling. Standard practice recommends against routine use of laboratory tests or imaging because simple cases are diagnosed visually and tests rarely change the initial treatment plan.
However, doctors must order blood cultures if the patient shows signs of system toxicity (severe illness like sepsis), if they are immunocompromised, or if the infection resulted from an animal bite or water injury. Selectively growing bacteria and testing them on narrow antibiotics is how we fight antibiotic resistance in our community.
Similarly, doctors only perform skin swabs if they find a visible break in the skin or pus.
Even though they are not specific, common blood tests like the C-reactive protein (CRP) and white blood cell count can also support the diagnosis of an infection, though normal results do not eliminate the possibility of cellulitis.
Doctors only consider imaging, such as ultrasound, when they suspect complications like an abscess (a localized collection of pus) or a serious deep-tissue infection.
Cellulitis symptoms primarily come from a rapidly spreading bacterial infection in the deep skin layer and underlying fat, characterized by a set of localized signs and, often, general illness. Look for any signs of skin breakage, including tiny inset bites or nicks between the toes.
The local signs of cellulitis, which typically appear on one part of the body (most often the lower leg), include:
The affected area becomes red or discolored (which may look less obvious on darker skin tones) and feels hot when you touch it.
The skin swells up (edema), feeling tight or tense, and is very painful and tender.
In more severe cases, the swelling can make the skin look slightly pitted, like an orange peel, or cause fluid-filled blisters. You might also see red streaks spreading away from the main site, which means the infection is tracking through the lymphatic vessels.
The body’s fight against the bacteria often causes general symptoms that indicate a spreading infection:
The patient develops a fever and experiences chills. They also often feel generally unwell or fatigued.
The infection causes nearby lymph nodes (glands) to become enlarged and tender.
If a person has severe symptoms like rapid heart rate, confusion, or very low blood pressure, the infection may have progressed to sepsis, which requires immediate medical help.
Recent studies suggest that components of medical marijuana, specifically cannabidiol (CBD), offer symptom relief because they possess anti-inflammatory, analgesic, and antimicrobial properties that synergize with antibiotics.
Doctors usually recommend this method because it targets the affected area directly without causing psychoactive effects. Cannabinoids interact with various skin receptors and reduce inflammation, redness, and swelling (edema) in the area. Topical products also alleviate the localized pain and tenderness characteristic of cellulitis.
A 2025 review of preclinical studies of CBD and skin health summarizes many of CBD’s antibacterial activities known to date. Strikingly, authors state how “…CBD shows potent antibacterial activity against many drug-resistant bacteria like MRSA, VRSA, and Salmonella…CBD has comparable efficacy to conventional antibiotics, such as ampicillin, and can be enhanced when combined with other antimicrobial treatments. CBD’s antibacterial properties also make it a promising candidate for managing acne and other bacterial infections.”
This method involves using products like CBD oil or softgels to help with overall body symptoms. Oral cannabinoids provide general pain and anxiety relief when cellulitis causes widespread discomfort. CBD may also help moderate the body’s general inflammatory response to the bacterial infection, including potentially aiding antibiotics in doing their job, based on early lab research.
Experts advise that patients must consult a doctor before starting cannabis, as cellulitis can spread and become serious quickly, and it may cause drug interactions with other medications. Patients should also choose high-CBD products because they provide therapeutic relief without psychoactive or immune-dampening effects of THC via CB2 that may lower your ability to fight an infection.
Cellulitis is a common, serious bacterial skin infection that affects the deep layer of the skin (dermis) and the fat and tissues just beneath it.
Cellulitis occurs when bacteria (most commonly streptococcus or staphylococcus) enter the body through a break in the skin, which includes a minor cut, scrape, insect bite, surgical wound, puncture, or chronic conditions like diabetes, vascular disease, eczema, or athlete’s foot.
Peripheral neuropathy from other causes or medication can indirectly raise risk if you can’t tell you’ve been injured.
The most common causes of cellulitis are the streptococcus and Staphylococcus aureus bacteria species. These bacteria normally live harmlessly on the skin, but cause infection when they enter the body through a break or wound in the skin barrier.
Cellulitis symptoms primarily show a rapidly spreading infection characterized by both local signs and general illness.
The affected skin gets red or discolored, feels hot to the touch, swells (edema), and is very painful and tender. The patient often develops a fever and experiences chills, along with swollen lymph nodes.
Cellulitis is highly common with injection drug use, where unsterile practices (like using dirty needles or “skin popping”) directly introduce bacteria into the tissue.
However, oral drug use does not cause cellulitis directly, but chronic substance abuse weakens the immune system and often leads to poor hygiene, increasing the user’s overall risk for any skin infection.
No, cellulitis itself is not contagious.
It is an infection of the deep skin layers caused by bacteria (usually strep or staph) that enter through a break in the skin. Transmission to another person through casual contact is not common.
Cellulitis is primarily treated with antibiotics because it is a bacterial infection.
Mild cases use oral antibiotics (tablets) for 5–10 days. Severe cases, or those not improving, require blood cultures, intravenous (IV) antibiotics, and supportive treatment in a hospital setting.
People are at high risk for cellulitis if they have diabetes, vascular disease, a weakened immune system, or chronic swelling, as these conditions compromise the skin’s defense. Major risk factors also include any breaks in the skin like cuts, ulcers, or athlete’s foot, and especially intravenous drug use.
Written by Chiagozie Ekemezie
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