Lymphoedema and Cellulitis
People living with lymphoedema have a significantly increased risk of developing cellulitis, a bacterial skin infection that can progress quickly if left untreated. Understanding the link between lymphoedema and cellulitis is essential for recognising the early warning signs, seeking timely medical treatment, and implementing effective management strategies to reduce the risk of recurrent infections and prevent further damage to the lymphatic system.
What is Cellulitis?
Cellulitis is a bacterial infection affecting the skin and underlying soft tissues, most commonly caused by Streptococcus or Staphylococcus bacteria. The infection occurs when these bacteria enter the body through a break in the skin. Sometimes the break is obvious, such as a cut, insect bite or surgical incision. Other times it can be something as simple as dry, cracked skin, eczema or a fungal infection, that allows an easy entry point for bacteria.
The infection triggers an inflammatory process, causing redness, warmth, swelling and pain, and can spread beyond the localised tissues quickly if left untreated. Prompt medical assessment and antibiotic treatment are essential, as cellulitis can affect both the skin surface and the deeper underlying tissues. In severe cases, bacteria can enter the bloodstream or lymphatic system, leading to serious complications such as sepsis (a life-threatening systemic response to the infection).
Why Does Lymphoedema Increase the Risk of Cellulitis?
The lymphatic system plays an important role in immune function by filtering bacteria, viruses and other harmful substances from the body’s tissues. It contains specialised immune cells called lymphocytes that help identify and fight infections, while lymph nodes act as filtering stations where harmful organisms and waste products can be detected and removed. The lymphatic system also helps transport excess fluid away from tissues, supporting normal fluid control and allowing immune cells to move throughout the body to respond to infection.
When lymphoedema is present:
- Fluid (lymph) accumulates within the tissues, creating an environment where bacteria thrive. The excess fluid is rich in proteins and nutrients that provide an ideal environment for bacteria to multiply rapidly once they enter the skin through a cut, scratch, insect bite, or other small break.
- Reduced lymphatic drainage limits the body’s ability to remove bacteria, waste products and other harmful substances from the tissues. Stagnant fluid weakens the body’s natural defence against infection, increasing the risk of cellulitis.
- Tissue swelling can compromise circulation and oxygen delivery, reducing the ability of tissues to repair and defend against infection. Poor circulation can impair immune function and slow healing, increasing the likelihood that an infection will develop or worsen.
- Skin integrity can become compromised due to stretching, dryness and tissue changes associated with swelling. Swollen skin is more vulnerable to cracks, irritation and breakdown, creating easy entry points for bacteria.
- Even minor skin disruptions can allow bacteria to enter and trigger cellulitis. Small cuts, scratches, insect bites, blisters or cracks in dry skin can be enough for bacteria to enter when the lymphatic system is not functioning effectively.
As a result, people living with lymphoedema are considerably more susceptible to developing cellulitis than those with a healthy lymphatic system. Unfortunately, the relationship also works in reverse where each episode of cellulitis can further damage the lymphatic system, potentially worsening lymphoedema and increasing the likelihood of future infection.
Signs and Symptoms of Cellulitis
Cellulitis often develops quickly, with symptoms worsening over hours rather than days.
Common signs/symptoms of cellulitis include:
- Sudden redness that continues to spread
- Increased warmth of the skin
- Pain or tenderness
- Increased swelling
- Skin that feels tight or shiny
- Fever or chills
- Feeling generally unwell or fatigued
- Flu-like symptoms
- Swollen lymph nodes
If you have lymphoedema, any sudden increase in swelling, redness or pain should be assessed promptly by a medical practitioner.
How is Cellulitis Treated?
Treatment for cellulitis usually involves:
- Oral antibiotics
- Rest
- Elevation of the affected limb
- Adequate hydration
- Pain relief if required
More severe infections may require:
- Intravenous (IV) antibiotics
- Hospital admission
- Ongoing medical monitoring
It is important to complete the entire course of antibiotics, even if symptoms improve within a few days.
Preventing Cellulitis
Although cellulitis cannot always be prevented, taking proactive steps to care for your skin and manage your lymphoedema can significantly reduce your risk of developing an infection.
1. Practice Good Skin Care
Healthy, well-maintained skin is your body’s first line of defence against infection. Even small breaks in the skin can allow bacteria to enter and lead to cellulitis.
Aim to:
- Moisturise your skin daily using a fragrance-free moisturiser to prevent dryness and cracking
- Keep your skin clean and dry, paying particular attention to skin folds and between the toes
- Inspect your skin every day for cuts, scratches, blisters, insect bites, rashes or other signs of injury
- Clean any cuts or grazes promptly with clean water, apply an appropriate antiseptic if recommended, and cover with a clean dressing until healed
- Avoid scratching itchy skin or insect bites, as this can damage the skin and increase the risk of infection
- Manage dry skin, eczema or other skin conditions promptly to maintain the skin’s protective barrier
2. Treat Fungal Infections Early
Fungal infections, such as athlete’s foot and fungal nail infections, are a common cause of cellulitis in people with lymphoedema. They create small cracks and breaks in the skin that allow bacteria to enter.
To reduce your risk:
- Check your feet regularly, particularly between the toes
- Keep your feet clean and dry
- Treat athlete’s foot and fungal nail infections as soon as they develop using appropriate anti fungal treatments
- Seek advice from your healthcare provider if the infection persists or recurs
3. Protect Your Skin from Injury
Everyday activities can result in small skin injuries that increase the risk of infection. Taking simple precautions can help protect your skin.
Consider:
- Wearing gloves while gardening, cleaning or performing manual tasks
- Using insect repellent and wearing long sleeves or pants when outdoors to reduce insect bites
- Wearing well-fitting, supportive footwear both indoors and outdoors
- Avoiding walking barefoot, particularly outside or on rough surfaces
- Taking care when shaving by using an electric razor or shaving carefully to avoid cuts
- Using sunscreen to prevent sunburn
- Taking care around pets to avoid scratches or bites
4. Manage Your Lymphoedema
Keeping your lymphoedema well managed can help reduce swelling, improve skin health and lower the risk of recurrent cellulitis. An individualised management plan developed with an Accredited Lymphoedema Practitioner is the most effective approach.
Your treatment plan may include:
- Wearing prescribed compression garments.
- Manual lymphatic drainage
- Regular exercise to encourage lymphatic flow and maintain mobility
- Daily skin care to protect the skin barrier
- Maintaining a healthy weight
- Elevating the affected limb when recommended
- Attending regular reviews with an Accredited Lymphoedema Practitioner to monitor your condition and adjust your treatment plan as needed
Consistent self-management and early intervention when problems arise can significantly reduce the likelihood of recurrent cellulitis and help keep your lymphoedema under control.
Recurrent Cellulitis
Unfortunately, once someone has experienced cellulitis, the risk of future episodes increases.
Repeated infections can:
- Further damage lymphatic vessels
- Increase swelling
- Further compromise tissue health
- Lead to chronic skin changes
- Create a cycle of worsening lymphoedema and recurrent infection
People experiencing recurrent cellulitis should discuss ongoing prevention strategies with their GP and lymphoedema therapist. In some cases, long-term preventative antibiotics may be considered under medical supervision.
How Hunter Rehab Hub Can Help
At Hunter Rehab Hub, our team provides comprehensive assessment and management of lymphoedema.
We can help you with:
- Comprehensive lymphoedema assessment
- Individualised management plans
- SOZO readings to determine fluid levels
- Complete Decongestive Therapy (CDT)
- Compression garment assessment, prescription and fitting
- Manual lymphatic drainage
- Exercise prescription
- Skin care education
- Strategies to reduce your risk of cellulitis
- Ongoing monitoring and support
Our goal is to help you manage your lymphoedema with confidence while reducing the risk of complications such as cellulitis.
Key Takeaway
Cellulitis is a potentially serious bacterial skin infection that requires prompt medical treatment. People living with lymphoedema are at greater risk due to changes in the lymphatic system, making prevention, early recognition and timely treatment essential.
By maintaining healthy skin, managing lymphoedema effectively and seeking medical attention as soon as symptoms develop, you can reduce the risk of serious complications and help protect your long-term lymphatic health.
Frequently Asked Questions (FAQs)
Can cellulitis make lymphoedema worse?
Yes, each episode of cellulitis can cause inflammation and damage to the lymphatic vessels, potentially reducing lymphatic function further and worsening lymphoedema. This can also increase the risk of future infections.
Is cellulitis contagious?
No, cellulitis is not contagious and cannot be spread from person to person through normal contact.
Should I continue wearing my compression garment if I have cellulitis?
In many cases, compression garments are temporarily removed while the acute infection is being treated. Once the infection begins to settle and your treating doctor or lymphoedema therapist advises it is appropriate, compression therapy is usually reintroduced to help manage the increased swelling. Your treatment plan should always be individualised based on your symptoms and advice from your healthcare team.
Can I have manual lymphatic drainage (MLD) if I have cellulitis?
No, manual lymphatic drainage is not recommended during an acute episode of cellulitis because stimulating lymph flow when there is an active infection can potentially contribute to the spread of bacteria through the lymphatic system. Your healthcare team will advise you when it is safe to recommence MLD treatment.
Can cellulitis come back?
Yes, previous episodes of cellulitis increase the risk of recurrence. Ongoing lymphoedema management, good skin care and early management of any skin injuries can help reduce this risk.
Can cellulitis occur without a visible break in the skin?
Yes, the entry point for bacteria is not always obvious. Small cracks, dry skin, fungal infections or minor skin damage may allow bacteria to enter, even when there is no noticeable wound.
What is the difference between cellulitis and a lymphoedema flare-up?
Both cellulitis and lymphoedema flare-ups can involve increased swelling and discomfort. However, cellulitis is an infection that often causes increasing redness, warmth, tenderness and pain, and may be associated with feeling generally unwell. If you are unsure, seek medical advice.
When should I seek medical attention for cellulitis?
If you suspect cellulitis, seek medical advice promptly, as early treatment can help prevent the infection from progressing. Urgent medical assessment is required if symptoms are rapidly worsening or you feel significantly unwell.
References
Australian Lymphology Association. (2023). Management of lymphoedema and related conditions: Position statements and clinical guidance.
Borman, P. (2018). Lymphedema diagnosis, treatment, and follow-up from the view of physical medicine and rehabilitation specialists. Turkish Journal of Physical Medicine and Rehabilitation, 64(3), 179–197.
International Society of Lymphology. (2023). The diagnosis and treatment of peripheral lymphedema: 2023 Consensus Document of the International Society of Lymphology. Lymphology, 56(4), 133–150.
Keeley, V., & Quere, I. (2022). Cellulitis in lymphoedema: Risk factors, prevention and management. British Journal of Community Nursing, 27(Suppl 4), S6–S12.
Lymphoedema Support Network. (2024). Cellulitis and lymphoedema.
National Institute for Health and Care Excellence. (2023). Cellulitis and erysipelas: antimicrobial prescribing (NG141).
Disclaimer
This content is general in nature and provided for educational purposes only. It is not a substitute for individualised medical advice, diagnosis, or treatment. If you have concerns about your symptoms or health, consult a qualified healthcare professional.
