Condition

Cellulitis

Cellulitis is a bacterial infection of the deeper layers of the skin and the fat underneath. The area becomes swollen, warm, tender and discolored, and it spreads. It needs antibiotics, and some presentations need care the same day.
16:9 hero for Cellulitis. Never cropped: the tone strip and the corner logo depend on the full frame.

Start here

Cellulitis is the one condition here where I would rather you came in unnecessarily than waited - it is a deep infection, it spreads, and it needs antibiotics, not a cream and not time. If an area of skin is swollen, warm to the touch, tender and getting bigger over hours, that is a same-day problem. Compare it with the other leg, because cellulitis is nearly always in one limb, and two matching legs usually means stasis dermatitis from long-term swelling and poor vein flow, which gets treated with antibiotics again and again when it should not be. Expect the skin to look worse for a day or two even when the antibiotic is working - what matters is the fever, how you feel in yourself, and whether the edge is still advancing after 48 hours, so draw a pen line around the border and note the time.

— Dr. Schwarz, Board Certified Dermatologist

Key Facts

How commonCommon. It is one of the most frequent reasons people are admitted to hospital for a skin problem
Who gets itAdults far more than children, most often in the lower leg. More likely with leg swelling, diabetes, obesity or a previous episode
Curable or managedCurable with antibiotics, but it comes back in a significant number of people, especially with ongoing leg swelling
Prescription neededYes, always. Cellulitis cannot be treated without antibiotics
Time to improveFever and how unwell you feel usually improve in 24 to 48 hours. The skin can take 1 to 2 weeks to settle fully

What It Is

Cellulitis is a bacterial infection of the dermis - the living layer beneath the skin surface - and the fat below it. It is deeper than impetigo, which stays on the surface, and that depth is why it causes swelling, fever and a genuinely unwell feeling instead of crusted sores.

Most cases are streptococcal, particularly Streptococcus pyogenes and related types. Staphylococcus aureus accounts for a smaller share, and is more likely with a wound, a boil or pus. The bacteria get in through a break in the skin and spread sideways through the deeper tissue, and because they are diffusing outward the edge is vague rather than sharp.

The area becomes swollen, warm, tender and discolored, and expands over hours to days. The skin can look tight, shiny or dimpled like orange peel, and blisters form if the swelling is severe. Fever, chills, a fast heart rate and a general sense of being ill are common, and can start before the skin looks wrong.

Cellulitis is almost always one-sided. Around eight in ten cases involve a lower leg. It is not contagious - you cannot catch it from someone who has it.

Erysipelas is a more superficial version affecting the upper dermis. It has a sharply raised, clearly defined edge, comes on faster, is more often on the face, and is usually streptococcal. The two overlap and are treated similarly.

Symptoms

Warm, tender, growing

Early Spreading Redness

A patch of skin that is red, warm, swollen and sore, usually on one leg, and getting bigger over hours. The border is often blurred rather than sharp. Marking the edge with a pen makes it easy to see whether it is spreading.
Bubbles over the redness

With Blisters

The same hot, tender redness, with blisters or fluid-filled bubbles across the surface. Blistering means the swelling is severe rather than that the infection is a different one. Skin that breaks open needs cover to prevent a second infection.
Whole-body symptoms

With Fever and Feeling Unwell

Redness on the skin along with fever, chills, a fast heartbeat or feeling confused. This means the infection is affecting more than the skin. It is an urgent problem and should be seen the same day.

How It Looks by Skin Tone

One lower leg on light skin with a large bright pink-red area that is swollen and tight-looking, with a shiny surface and a blurred edge where it fades into normal skin.One lower leg on medium tan skin with a large dusky pink-brown area that is swollen and tight-looking, with a shiny surface and no clear edge.One lower leg on brown skin with a large area that is slightly darker and more violet than the skin beside it, swollen and tight-looking. The color change is subtle and has no clear edge.One lower leg on deep brown skin with a large swollen, tight-looking area that is only slightly darker and grayer than the skin beside it. The color change is very subtle and has no clear edge.
LightMediumBrownDeep

Cellulitis is described everywhere by redness, and redness is the hardest sign to see on deeper skin tones. Inflammation there often looks brown, violet, gray or simply darker, and on very deep skin tones it can be subtle enough to miss entirely, clinicians included. Cellulitis is diagnosed later on average in people with deeper skin tones, and later diagnosis means a higher chance of hospital.

Use the signs that do not depend on color. Warmth, felt with the back of the hand and compared with the same spot on the other limb. Swelling, again compared side to side. Tenderness. Tightness or shine. And spread - an area bigger tonight than this morning. Mark the edge with a pen and write the time. At the appointment, say it directly: "this area is warmer, more swollen and more tender than the other leg, and it has grown since this morning." That carries more weight than asking whether something looks red. Afterward the skin where the infection was is often darker for weeks to months. That is post-inflammatory hyperpigmentation - flat discoloration left by inflammation, not remaining infection - and it does not need more antibiotics. Peeling and mild scaling as it settles is normal.

Where It Shows Up

Front view of a whole body with red marks down one lower leg, over the shin, calf, ankle and foot. The other leg and the rest of the body are clear.
One lower leg, far more often than anywhere else
About eight in ten cases are in a lower leg, and one leg alone is the pattern. Both legs red at once is usually something else. Where it lands normally follows where the skin was broken — a cut, a bite, a crack between the toes or a patch of athlete's foot.
Front view of a whole body with red marks down one arm from the upper arm to the hand, and on one side of the face around the eye and cheek. The rest of the body is clear.
An arm, or the face
It can also affect an arm, most often one that swells after lymph node surgery. On the face it usually takes one cheek or the skin around one eye, and swelling near an eye is treated urgently.

What Happens in the Skin

This is what is going wrong under the skin, in the order it happens. Click a step to see it.

How Cellulitis happens
Skin basics
BARRIEREPIDERMISDERMIS0NORMAL SKIN1A BREAK IN THE SKIN2BACTERIA GET THROUGH THE BREAK3THEY SPREAD SIDEWAYS4SWELLING LETS IT KEEP SPREADING

Healthy skin is an unbroken sheet laid over the living layer and the fat beneath it. Bacteria sit on that surface all the time and cause no trouble there. Nothing reaches the deeper layer while the surface stays closed.

Something opens the barrier. It is usually small and easy to miss - cracked, peeling skin between the toes from athlete's foot, a graze, an insect bite, a cracked heel, a patch of eczema or a leg ulcer.

Bacteria that already live on normal skin, usually streptococci, pass through that opening into the deeper living layer. This is why cellulitis is not caught from another person.

In the deeper layer the bacteria multiply and move outward in every direction rather than staying in one spot. There is no wall to stop them, which is why the edge is blurred and why the area grows over hours.

Fluid sitting in a swollen limb keeps immune cells away and gives bacteria room to travel, and the infection damages lymph channels, which makes the limb swell more. That loop is why episodes repeat, and nearly everything on the lists below is aimed at it.

The outer film of dead cells and oil. It holds water in and keeps irritants out, and it is thinner than a sheet of paper. Almost every dry, itchy, stinging skin problem starts here.

The outer layer, and the only one anything in a jar reaches. It renews itself constantly: a cell made at the bottom takes about a month to reach the surface and flake off. Most of what a skincare product does, it does here.

The living layer underneath, holding the blood vessels, the nerves and the collagen. It is where lasting change happens and it is hard to reach: most of what is sold for the skin never gets this far.

Three parts. First, a break in the skin, often small and overlooked - cracked skin between the toes from athlete's foot is the classic one, along with cuts, grazes, insect bites, leg ulcers, cracked heels, eczema, surgical wounds and injection sites. Sometimes none is ever found.

Second, bacteria get through into the deeper tissue. Streptococci usually, Staphylococcus aureus less often and more typically with a wound or abscess. Both live on normal skin, so the bacteria are usually already yours.

Third, the tissue has to let them spread, and this is where the risk factors matter more than the exposure. Swollen limbs, poor lymph drainage and poor vein flow leave fluid sitting in the tissue with reduced immune access, so bacteria that would normally be dealt with quietly multiply and move outward. That is why cellulitis so often hits a leg that already swells, and why one episode makes the next more likely - it damages lymph channels, swelling increases, risk increases again.

The swelling and heat are mostly immune response, not bacteria. That is also why the area can look worse for a day or two after treatment starts; dying bacteria release material that briefly intensifies the reaction.

Risk Factors

This is about the state of the limb and the skin barrier, not hygiene or contact with other people.

Breaks in the skin
Athlete's foot and cracked skin
The entry point most often identified, and one you can fix.
Breaks in the skin
Leg ulcers and chronic wounds
A permanent open door.
Breaks in the skin
Eczema, psoriasis and any broken skin
Anything that breaches the barrier, scratching included.
Breaks in the skin
Insect and animal bites
Bites push bacteria in. Cat bites especially need medical attention.
Breaks in the skin
Injecting drug use
A well-recognized cause of skin and soft tissue infection.
Swelling & circulation
Leg swelling from any cause
Lymphedema, venous insufficiency, heart failure and post-surgical swelling all raise the risk and make recurrence likely.
Swelling & circulation
Obesity
A consistent risk factor, partly through limb swelling and lymph flow.
Swelling & circulation
Surgery involving lymph nodes
Removing nodes, as in breast cancer surgery, raises the risk in that limb long term.
Swelling & circulation
Peripheral arterial disease
Poor blood supply means less immune access and slower healing.
Other health conditions
A previous episode of cellulitis
The strongest predictor of another. Each episode damages lymph drainage.
Other health conditions
Diabetes
More likely, more severe, more often the foot. Reduced sensation means an entry wound goes unnoticed.
Other health conditions
A weakened immune system
Chemotherapy, immune-suppressing medicines, HIV and transplant medicines.
Age
Older age
Thinner, more easily broken skin, plus more of the conditions above.

Course

Cellulitis moves fast - over hours rather than weeks, and it needs treatment, not time.

StartingHours 0 to 24
It can begin before the skin looks wrong

A small area turns tender, warm and swollen, usually on one lower leg, and discoloration follows. Fever, chills or simply feeling unwell can come first.

One lower leg
SpreadingDays 1 to 3 untreated
The area expands outward with an unclear edge

The skin tightens and may look shiny or dimpled. Blisters can appear. Fever and illness increase.

TurningFirst 24 to 48 hours of antibiotics
You feel better before the skin looks better

Fever settles first. The skin often looks the same or slightly worse for a day or two, which is expected. What should stop is the edge advancing.

SettlingDays 3 to 7 of treatment
Swelling and tenderness ease

Discoloration fades. A typical course of oral antibiotics runs about 5 to 7 days, longer if improvement is slow.

ClearingWeeks 1 to 3, then months
Peeling, then a mark that fades slowly

The skin peels as it recovers, and a darker or lighter mark fades slowly, especially on deeper skin tones. Mild lasting swelling is common. So is another episode, particularly if the limb still swells or the athlete's foot was never treated; for repeated episodes doctors sometimes prescribe a long-term low-dose antibiotic.

What Makes It Better & Worse

Cellulitis is four problems — a break in the skin, bacteria getting in, bacteria spreading, and swelling that lets them. Cellulitis that keeps coming back is usually a limb problem, not an antibiotic problem.

What is driving yours?

FATBARRIEREPIDERMISDERMIS

Something opens the barrier. It is usually small and easy to miss - cracked, peeling skin between the toes from athlete's foot, a graze, an insect bite, a cracked heel, a patch of eczema or a leg ulcer.

Bacteria that already live on normal skin, usually streptococci, pass through that opening into the deeper living layer. This is why cellulitis is not caught from another person.

In the deeper layer the bacteria multiply and move outward in every direction rather than staying in one spot. There is no wall to stop them, which is why the edge is blurred and why the area grows over hours.

Fluid sitting in a swollen limb keeps immune cells away and gives bacteria room to travel, and the infection damages lymph channels, which makes the limb swell more. That loop is why episodes repeat, and nearly everything on the lists below is aimed at it.

What helps

  • Treat athlete's foot and keep treating it Closes the main entry point.
  • Look after your legs Plain moisturizer, treat eczema, short nails.
  • Clean and cover breaks in the skin Get bites and punctures assessed.
  • Check your feet daily With diabetes or reduced sensation.

What makes it worse

  • Untreated athlete's foot The commonest entry point.
  • Unnoticed cuts and cracks on the feet Easy to miss with numb feet.
  • Scratching eczema, psoriasis or bites Every scratch is an entry point.
  • Leg ulcers and chronic wounds A continuously open barrier.

What helps

  • Antibiotics, started promptly Oral usually, intravenous if severe or spreading fast.
  • Mark the edge with a pen and the time The clearest sign it is working.
  • Take the whole course Feeling better in two days is expected.
  • Ask about preventive antibiotics A long-term low dose for repeated episodes.
  • Get reassessed at 48 hours No improvement means wrong antibiotic, pus, or another diagnosis entirely.

What makes it worse

  • Delaying treatment It expands over hours.
  • Stopping antibiotics early An unfinished course invites a return.
  • Treating it as a rash Steroid creams do not treat infection.
  • Assuming both legs at once is cellulitis Usually stasis dermatitis.

What helps

  • Elevate the limb, properly and often Above heart level, for real stretches.
  • Manage ongoing leg swelling The main lever against recurrence.

What makes it worse

  • Leg swelling that is never addressed Why episodes repeat.
  • Leaving the leg down all day Elevation is treatment.
  • Skipping prescribed compression stockings Swelling control prevents the next one.

How These Treatments Work

Treatments for Cellulitis do not all work in the same place. Tap one to see where it acts.

Pick a treatment
Skin basics
BARRIEREPIDERMISDERMISKILLS THE BACTERIABRINGS SWELLING DOWNCLOSES THE DOORPREVENTS THE NEXT ONE

Bacteria got through a break in the skin into the tissue below. This is the treatment.

Helps the fluid drain while the antibiotic does the work.

Athlete's foot, a cut or eczema is usually how it got in. Treating that prevents the next one.

Intact skin is the barrier that keeps bacteria out.

The outer film of dead cells and oil. It holds water in and keeps irritants out, and it is thinner than a sheet of paper. Almost every dry, itchy, stinging skin problem starts here.

The outer layer, and the only one anything in a jar reaches. It renews itself constantly: a cell made at the bottom takes about a month to reach the surface and flake off. Most of what a skincare product does, it does here.

The living layer underneath, holding the blood vessels, the nerves and the collagen. It is where lasting change happens and it is hard to reach: most of what is sold for the skin never gets this far.

Over-the-Counter Products

Everything here you can buy without seeing anyone.

Compression stockings
Compression stockings
Strong evidence
For someone whose leg swells, properly fitted compression is the single best way to prevent the next episode, and a trial in people with repeated cellulitis showed clearly fewer episodes. They are for prevention, not for an active infection. Get the fitting checked first, because compression is not safe with poor arterial circulation.
Elevating the limb
Elevating the limb
Moderate evidence
Raising the affected leg above heart level for real stretches of the day drains fluid out of the tissue and speeds up how fast the swelling and discomfort settle. It is part of the treatment rather than comfort advice, and it works alongside antibiotics, never instead of them.
Acetaminophen and ibuprofen
Acetaminophen and ibuprofen
Moderate evidence
These cover the pain and bring the fever down while the antibiotics do the work. Taking them regularly for the first couple of days works better than waiting for the pain to peak. They do not treat the infection, and pain that is far worse than the skin looks is a reason to be seen urgently rather than to take more.
16:9 hero for Terbinafine. Never cropped: the tone strip and the corner logo depend on the full frame.
Terbinafine cream
Moderate evidence
Athlete's foot between the toes is the most commonly identified way bacteria get into a leg, and it is one of the few entry points you can genuinely close. An antifungal cream used on the toe webs for two to four weeks, and repeated whenever the skin cracks again, lowers the chance of another episode. It does nothing for the infection you have today.
A white cream tube lying on its side on a white background, with a plain white label reading Antibiotic Ointment and a yellow swoosh beneath it.
Antibiotic ointment from the shelf
Weak evidence
Cellulitis sits below the surface, deeper than any cream reaches, so an over-the-counter antibiotic ointment cannot treat it. Using one and watching for a day is a common reason people arrive later than they should. It is reasonable on a small fresh cut to keep it clean, and that is all.

Prescriptions

These need a prescription.

16:9 hero for Mupirocin. Never cropped: the tone strip and the corner logo depend on the full frame.Diagram: how Mupirocin works in the skin
Limited evidence
Useful only for the small crusted sore or infected wound that let the bacteria in, not for the cellulitis itself, which is far too deep for a cream to reach. Treating the entry point matters, but it happens alongside antibiotic tablets, never instead of them.
A white cream tube lying on its side on a white background, with a plain white label reading Steroid Cream and a blue swoosh beneath it.
Steroid creams
Never use
A steroid cream calms the look of inflamed skin without touching the infection underneath, so it can quieten the appearance while the infection carries on spreading. Cellulitis is mistaken for a rash often enough that this is worth saying plainly. If a leg is hot, swollen, tender and growing, it needs assessing, not a steroid.
An amber prescription bottle lying on its side on a white background with a plain white label reading Cephalexin, and six small round white tablets spilled out in front of it.
Cephalexin
Always
The usual first choice for ordinary cellulitis, taken four times a day for about five to seven days. It covers the streptococci behind most cases and many staph as well. Antibiotics are not optional here - there is no version of cellulitis that clears without them - and the course is finished even though you feel better in two days.
An amber prescription bottle lying on its side on a white background with a plain white label reading Doxycycline, and six small round white tablets spilled out in front of it.Diagram: how Doxycycline works in the skin
Strong evidence
Used when MRSA is a concern, when there is pus or a boil involved, or when penicillins do not suit. It is often paired with a second antibiotic because it covers strep less reliably on its own. It is avoided in pregnancy and in young children, and it makes sunburn more likely.
An amber prescription bottle lying on its side on a white background with a plain white label reading Bactrim, and six small round white tablets spilled out in front of it.
Trimethoprim-sulfamethoxazole
Strong evidence
The other main option when MRSA is suspected, particularly with an abscess or a draining wound. Like doxycycline it is often combined with an antibiotic that covers strep properly. It needs care with kidney problems and with some other medicines, so tell the prescriber everything you take.
An amber prescription bottle lying on its side on a white background with a plain white label reading Antibiotics, and six small round white tablets spilled out in front of it.
Low-dose preventive antibiotics
Strong evidence
For people who keep getting episodes, a small daily dose of penicillin taken for months roughly halves how often they come back. The effect fades once it is stopped, so it works best alongside compression and treating the entry point. Ask about it if you have had two or more episodes.
A white metal tube lying at an angle on a white background, white ribbed cap to the left, labeled Clindamycin in black lettering with a teal swoosh curving beneath the word.Diagram: how Clindamycin works in the skin
Moderate evidence
An alternative for a genuine penicillin allergy, and it covers both strep and most staph. It causes diarrhoea more often than the others and carries a higher risk of a bowel infection called C. difficile, so it is usually not the first pick. Report diarrhoea that starts during or after the course.

Procedures

These are done in the office, usually over several visits.

No procedures listed yet.

When to See a Dermatologist

Cellulitis is not wait-and-see, and not one to wait for a dermatology appointment: it spreads over hours, and early antibiotics keep it out of hospital. Go to an emergency department now if the pain is far worse than the skin looks, if skin is turning dusky, purple, gray or black, if areas have gone numb, if there are blisters filled with dark fluid or skin breaking down, or if you have a high fever with shaking chills, confusion, a very fast heart rate or feel dramatically worse. Get same-day care for cellulitis on the face or around the eye, for a baby or young child, for anyone with diabetes, poor circulation or a weakened immune system, after a bite or water exposure, when dark streaks track up the limb, and for the ordinary version - one limb swollen, warm, tender, discolored and bigger than this morning. No single test confirms it, so it is diagnosed by examination, usually with a pen line drawn around the border so the edge can be measured the next day, and you should be seen again within 48 hours if the fever has not settled or the edge is still advancing.

— Dr. Schwarz, Board Certified Dermatologist

Complications

An abscess underneath

A pocket of pus can form inside the infected area, most often when Staphylococcus aureus is involved or there was a boil or wound to begin with. It shows up as a tender lump that feels boggy or fluid-filled, and it is a common reason antibiotics alone are not working at 48 hours. Pus has to be drained as well as treated, so this is a reason to go back rather than wait.

Swelling and repeat episodes

Each episode damages the lymph channels that drain the limb, so the limb swells more afterwards, and a limb that swells is more likely to be infected again. A previous episode is the strongest predictor of the next one. Compression, daily moisturizer and treating athlete's foot break the loop better than any antibiotic does.

Sepsis

The infection can reach the bloodstream and affect the whole body. The signs are a high fever with shaking chills, confusion or new drowsiness, a racing heart, fast breathing, feeling faint, or passing very little urine. It is uncommon but it is time-critical, so it is an emergency department problem rather than a next-day appointment.

Lookalikes

Stasis dermatitis

The most common thing mistaken for cellulitis, and the reason to look at both legs. Long-term leg swelling leaves skin that is discolored, dry and scaly around the ankles, and it itches more than it hurts. The giveaway is that it is on both legs, has been there for months, and comes without fever. Cellulitis is almost always one leg, arrives over hours, and is tender rather than itchy.

Deep vein thrombosis

A clot in a deep leg vein also makes one calf swollen, warm and sore, which is exactly the cellulitis picture. The differences are that a clot usually causes deep aching in the calf with much less color change on the surface, no clear entry wound, and no fever. Because both are one-sided and both are urgent, this one is separated by a scan rather than by looking, so it is worth telling the doctor if you have had recent surgery, a long flight or a previous clot.

Contact Dermatitis

A reaction to a plant, a cream or a dressing can leave a hot, swollen, discolored patch on one leg that looks a lot like early cellulitis. It itches rather than hurts, it often has a shape that matches whatever touched the skin, and it comes without fever or feeling unwell. It also tends to appear within a day or two of a new product being used.

Myths

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  • "Cellulitis is contagious." It is not It is an infection in your own deeper tissue, from bacteria that mostly already live on your skin. You cannot catch it from someone, and you do not need to stay away from family or work.
  • "Cellulitis and cellulite are related." They only sound similar. Cellulite is dimpled normal fat under the skin, usually on thighs and hips. Cellulitis is a bacterial infection that needs antibiotics.
  • "Red streaks running up the limb mean blood poisoning." Red or dark streaks tracking upward usually mean the infection has entered lymph channels - lymphangitis. Not sepsis, but it is progressing, and it should be seen the same day.
  • "If both legs look like this, it must be cellulitis in both." Cellulitis in both legs at once is uncommon. Symmetrical discoloration, scaling and itch, usually without fever, is more often stasis dermatitis from long-term swelling. It is among the most mistaken diagnoses in skin medicine, and it leads to antibiotic courses that were never going to help.
  • "It should look better within a day of antibiotics." The skin often looks the same or worse for a day or two while you start feeling better. What should stop is the spreading edge. Fever past 48 hours, or an advancing edge, means you need reassessing.
  • "An antibiotic cream will handle it." It will not. Cellulitis sits below the surface, deeper than any cream reaches. It needs antibiotics by mouth or vein.
  • "Once it has cleared, that is the end of it." Recurrence is common, particularly when the limb still swells or the athlete's foot was never treated. The work that prevents the next one happens after this clears.

Questions Patients Ask

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Is cellulitis contagious?

No. The bacteria already live on normal skin, and the infection is in your own deeper tissue. You cannot pass it on, and there is no need to isolate from family. Keep any open, draining wound covered - ordinary wound care.

Why does it look worse after I started antibiotics?

Common in the first 24 to 48 hours. Dying bacteria release material that briefly intensifies the immune reaction, so the area can look more inflamed while you improve. Watch how you feel, whether the fever settles, and whether the marked edge stops. If it is still spreading at 48 hours, go back.

How long will it take to go away?

You should feel better within one to two days, and a typical antibiotic course runs about 5 to 7 days. The skin takes one to two weeks to settle, and peeling is normal. Some swelling and a darker or lighter mark can persist for weeks to months, especially on deeper skin tones.

Do I need to be in hospital?

Most cellulitis is treated with tablets at home. Antibiotics into a vein are used when it is severe or spreading fast, with a high fever or signs of sepsis, when the face or around the eye is involved, when tablets have failed, or with diabetes, poor circulation or a weakened immune system.

Why does it keep coming back?

Usually because the limb still swells and the entry point was never closed. Long-term leg swelling, untreated athlete's foot, and lymph drainage damaged by a previous episode all make the next one more likely. Compression, moisturizing and treating the foot fungus do more than any antibiotic. If it keeps happening, ask about long-term preventive antibiotics.

Is this the same as cellulite?

No, and the similar names cause a lot of confusion. Cellulite is dimpled normal fat beneath the skin, a cosmetic matter. Cellulitis is a bacterial infection of the deeper skin that needs antibiotics and sometimes urgent care.

References

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