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Cellulitis (cont.)

When Is Surgery Needed for Cellulitis?

  • Rarely, a soft-tissue infection may need surgery.
  • An abscess, or collection of pus in the tissue, may need to be opened surgically to allow drainage.
  • Dead tissue may need to be cut away to stop the infection from progressing or to allow healing.

What Follow-up Is Needed After Treatment of Cellulitis?

Once you leave the doctor's office, be sure to take all the antibiotics prescribed. Do not stop taking the antibiotics early unless the doctor instructs you to stop. The doctor may want to see you in two to three days to make sure that the cellulitis is improving.

What Are Cellulitis Complications?

Severe cellulitis may cause spread of bacteria into the bloodstream (sepsis, or blood poisoning), which can be life-threatening. There are some very serious complications that are fortunately very rare, but awareness can be lifesaving.

The infected soft tissue may die (gangrene). Very severe cellulitis and tissue death may rarely spread deep inside to the muscle (necrotizing fasciitis). Necrotizing fasciitis or gangrene is an emergency. It is life-threatening if the dead tissue is not surgically removed (debridement or amputation). Necrotizing fasciitis may be present even if the surface of the skin does not look dead, so it is important to recognize signs and symptoms of this emergency. Signs and symptoms include worsening fevers even with antibiotics, deep pain that is worse than the infection appears, hardening of the tissues under the skin, and numbness of the surface of the skin.

Cellulitis around the eye is serious. If cellulitis is only in the tissues in front of the eye socket (orbit), it is preseptal cellulitis, and oral antibiotics may be enough to cure it. If the cellulitis is behind the eyeball or in the eye socket, it is orbital cellulitis. Orbital cellulitis is an emergency and can cause permanent loss of vision or spread of infection into the brain (meningitis). This is especially life-threatening in people with diabetes, iron-overload diseases (hemochromatosis), or liver disease. Orbital cellulitis may require hospitalization and treatment by an ophthalmologist (eye surgeon) or an ear, nose, and throat surgeon. Signs and symptoms of orbital cellulitis include loss of vision and difficulty moving the eyeball.

External ear infections (swimmer's ear) in a person with diabetes may become cellulitis, with severe swelling of the external ear canal (malignant otitis externa). Malignant otitis externa may spread deep into the ear and the skull bone. This may cause permanent hearing loss. A diabetic with worsening external ear infection should seek urgent care. The diagnosis often requires a computed tomography (CT) scan to evaluate the skull around the ear. An ear, nose, and throat surgeon is often involved in treatment, but usually it can be treated with antibiotics, and no surgery is needed.

The blood flow of the nose and upper lip drains back into the veins of the skull. Cellulitis around the nose may very rarely spread to cause infected blood clot in these veins (cavernous sinus thrombosis). This is life-threatening. Signs and symptoms of cavernous sinus thrombosis include headache, high fever, loss of consciousness, and bulging of one or both eyes.

Medically Reviewed by a Doctor on 9/21/2017

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Cellulitis is a term that describes the inflammatory response caused by bacteria in the skin below the epidermis.

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