Can cellulitis get progressively worse if left untreated?

From the Guidelines

Yes, cellulitis can definitely get progressively worse if left untreated, potentially leading to serious complications such as abscess formation, tissue death, or systemic infection. Cellulitis is a bacterial skin infection that typically begins as a red, swollen, painful area that feels warm to the touch. Without proper treatment, the infection can spread deeper into the skin and underlying tissues. The infection worsens because bacteria continue to multiply and spread without the intervention of antibiotics to kill them, as noted in the practice guidelines for the diagnosis and management of skin and soft-tissue infections 1. Key factors that contribute to the progression of cellulitis include:

• The body's immune response, which can contribute to increasing inflammation and tissue damage
• The presence of underlying conditions, such as diabetes, chronic venous insufficiency, or lymphedema, which can impair the body's ability to fight the infection
• The failure to address predisposing factors, such as edema or underlying cutaneous disorders, which can increase the risk of recurrent infection 1 Treatment typically involves oral antibiotics, such as cephalexin, dicloxacillin, or clindamycin, for 5-10 days, depending on severity, as recommended in the 2014 update by the Infectious Diseases Society of America 1. For more severe cases, hospitalization and intravenous antibiotics may be necessary. Early treatment is essential to prevent complications, so anyone experiencing symptoms of cellulitis should seek medical attention promptly rather than waiting to see if it improves on its own. Additionally, measures to reduce recurrences of cellulitis, such as treating interdigital maceration, keeping the skin well hydrated, and reducing underlying edema, should be taken to prevent further episodes 1.

From the Research

Cellulitis Progression

• Cellulitis can potentially get progressively worse if left untreated, as it is a condition that can lead to significant morbidity and, in severe cases, can be life-threatening 2.
• The progression of cellulitis is influenced by various factors, including the presence of underlying conditions that increase the risk of infection, such as local and systemic modifiable and nonmodifiable factors 3.

Treatment and Prevention

• The treatment of cellulitis with antibiotics is well established, and effectiveness is generally measured against biochemical and clinical outcomes 4, 5.
• However, prevention and treatment of recurrent cellulitis require a rigorous approach to managing risk factors and treating acute infection, as the risk of recurrence rises with repeated episodes 3.
• Antibiotic prophylaxis, such as penicillin V, can be used to prevent recurrence, but other antibiotics and new drugs can be considered in cases of β-lactam allergy, intolerance, or failure 3.

Consequences of Untreated Cellulitis

• Untreated cellulitis can lead to severe pain, flu-like symptoms, and delayed recognition of the condition, causing distress and anxiety for patients 2.
• Recurrent cellulitis is associated with short-term and long-term morbidity, as well as significant healthcare costs, highlighting the importance of preventing and treating this condition effectively 3.