Cellulite is an infection of the deep layers of the skin. It develops when bacteria enter through a cut, bite or wound – including tiny breaks in cracked, dry skin. Common bacteria that inhabit the skin, Staphylococcus the Streptococcus, are the usual culprits. Although cellulite can appear anywhere on the body, the most common location is the lower leg.
Dr. Arash Mostaghimi, a dermatologist at Brigham and Women’s Hospital and associate professor of medicine at Harvard Medical School, reviews new research that explores important questions about how long it takes for full healing.
What are the symptoms of cellulite?
The body’s natural immune response to this invading bacteria causes a painful rash that appears red on fair skin and dark purple on darker skin. The affected area may also be swollen and feel warm.
How is cellulite treated?
Standard treatment is five to 10 days of antibiotic pills. More severe cases may require intravenous antibiotics.
How quickly can antibiotics help resolve cellulitis?
After starting antibiotic treatment, people usually see improvement within a few days. However, the area may remain swollen, warm and painful even after 10 days.
Does this mean the antibiotic treatment was ineffective? Not necessarily, according to me a recent study of people with lower leg cellulite who described the natural history of healing stages after antibiotics.
“The healing process has two parts, which is why full recovery takes longer than you think,” says Dr. Mostaghimi.
First, antibiotics and white blood cells work together to kill bacteria. But your body’s immune response against the bacteria may take some time to stop. As a result, this second stage of the healing process may include some residual symptoms, he explains.
What did the study find?
The study included 247 people with mild to moderate shin cellulitis who received antibiotics for seven to 10 days. By day 10:
- Their swelling had decreased by 50%, and the size of the affected area had shrunk by about 55%.
- A marker of inflammation in the blood, C-reactive protein, fell during treatment and reached near-normal levels in all participants.
- However, more than half continued to report discomfort in the affected leg, with 14% rating their pain as 5 or greater on a scale of 1 to 10.
This pattern of discomfort is not uncommon, especially with foot infections, Dr. Mostaghimi says. As people recover from leg cellulitis, they are often advised to elevate the leg, which helps relieve swelling. (Placing a warm, damp towel over the area may also help.)
But after they feel better and start walking more, the fluid shifts back into the legs. So it’s not surprising that the area may feel a little swollen and uncomfortable again once they’re back on their feet, she says.
Who is most at risk of cellulite?
Remember, cellulite usually occurs when bacteria normally present on our skin manage to breach this shield to enter the body.
Some people who develop cellulitis have no obvious injury or damage to the skin that would explain the infection, which can occur in people who are generally healthy. However, people with certain health conditions are more prone to cellulite. This includes people who are overweight or have diabetes, a weakened immune system, poor circulation or chronic edema (swollen limbs).
Additionally, skin conditions like eczema and athlete’s foot can create small cracks in the skin that make it easier for bacteria to penetrate deeper into the skin, says Dr. Mostaghimi. Scratching a bug bite until it bleeds is another potential entry point for bacteria.
What happens if cellulite is not treated?
Untreated cellulite can be very serious. The rash may spread, blister and become increasingly painful. Nearby lymph nodes may become tender and swollen, followed by fever and chills. Seek medical attention immediately if you experience these symptoms.
The bottom line
“It’s important for people with leg cellulitis to realize that it may take a little longer after you finish your antibiotics for all of your symptoms to fully resolve,” says Dr. Mostaghimi. You will probably start to feel better within a few days, but always finish all the pills in your antibiotic prescription. However, having residual symptoms once you’re done doesn’t mean you need another round of antibiotics or a different antibiotic, she says.
