From the Guidelines
Yes, cellulitis can be chronic. Chronic cellulitis is often characterized by recurrent episodes of infection, which can lead to permanent damage to the lymphatic system and potentially cause lymphedema 1.
Risk Factors for Chronic Cellulitis
Several factors can contribute to the development of chronic cellulitis, including:
- Previous attacks of cellulitis, especially involving the legs 1
- Edema, particularly lymphedema 1
- Local risk factors such as venous insufficiency, prior trauma (including surgery) to the area, and tinea pedis or other toe web abnormalities 1
- Other predisposing conditions like obesity, tobacco use, a history of cancer, and homelessness 1
Management of Chronic Cellulitis
Management of chronic cellulitis involves addressing underlying risk factors and preventing recurrent episodes. This can include:
- Treating interdigital maceration and keeping the skin well hydrated with emollients 1
- Reducing underlying edema through elevation of the extremity, compressive stockings or pneumatic pressure pumps, and diuretic therapy if necessary 1
- Antimicrobial prophylaxis, such as monthly intramuscular benzathine penicillin injections or oral therapy with penicillin or erythromycin, may be considered for patients with frequent recurrences 1
- In some cases, providing oral antibiotics for patients to initiate therapy as soon as symptoms of infection begin may help shorten episodes 1
From the Research
Definition and Diagnosis of Cellulitis
- Cellulitis is an acute bacterial infection that affects the deep dermis and surrounding subcutaneous tissue 2
- It is often misdiagnosed because it can mimic a range of conditions that also cause inflamed, red, irritated and painful skin 2
Chronic Cellulitis
- While cellulitis is typically considered an acute infection, there is evidence to suggest that it can be chronic or recurrent 3, 4
- Recurrent cellulitis is common, and predisposing conditions should be assessed for and treated at the time of initial diagnosis 4
- Factors that predict recurrence of cellulitis include lymphedema, chronic venous insufficiency, peripheral vascular disease, and deep vein thrombosis 3