Cellulitis Introduction

:cellulitis.jpg Cellulitis is an infection caused by bacteria, which affect skin and deeper soft tissues. Upon infection, afflicted areas are usually red, swollen, and tender. The infection may also be accompanied by regionally swollen lymph glands. Cellulitis can have serious consequences because of its potential to spread through the lymphatic system and into the bloodstream (bacteremia). Bacteremia, sepsis, and other complications resulting from the intial infection require laboratory tests to determine the appropriate method of treatment. However, the development of such underlying complications are rare, and are often prevented by proper, and timely antibiotic treatment.

The lower extremities (legs and feet) are the most common sites of infection. Cellulitis is most commonly caused by the bacterial microorganism Streptococcus pyogenes. Occasionally, the bacterial microorganism Staphylococcus aureus causes cellulitis. Treatments for this form of bacterial infection are typically less extensive than that of streptococcus. Staph infections are, largely, the result of an open wound or cutaneous abscess. Cellulitis may also be preceded by a skin lesion such as an ulceration, puncture wound, or dermatitis. Fungal infections, like tinea pedis (athlete’s foot), may also increase the risk for onset of this condition.

Cellulitis Statistics

According to the Center for Disease Control (1);

  • An estimated 13.3 per 10,000 of the population were hospitalized for cellulitis in 1998 alone-

Cellulitis Symptoms

The general symptoms of cellulitis include:

  • Red, hot, swollen, and tender infection area
  • The affected skin surface may resemble the skin of an orange (peau d’orange)
  • Regionally swollen lymph glands
  • Fever and chills may be present
  • May have a history of skin trauma
  • Skin abscesses may form
  • A rare complication of bacteria invading the bloodstream (bacteremia)

Cellulitis Treatment

The affected Cellulitis area should be immobilized and elevated to help reduce swelling. Cool, wet dressings should be applied to the affected area to help relieve local pain and tenderness. The drug of choice for cellulitis is penicillin. For penicillin-allergic patients, erythromycin is an alternative for mild infections, and clindamycin can be used for severe cases. If there is pus or an open wound, a blood culture can be taken. Results should dictate the attending physician’s antibiotic choice. Mild to moderate infections may be treated with oral antibiotics. More severe cases of cellulitis may require hospitalization and I.V. antibiotics. Cellulitis symptoms usually resolve after a few days of antibiotic treatment.

Supplements helpful for Cellulitis Treatment

Bromelain Bromelain, a protein-digesting enzyme complex derived from pineapple, can enhance the absorption of antibiotics, making them more effective in killing bacteria (2, 3). Bromelain supplementation can be a useful adjunct in cellulitis treatments to help fight bacterial infection.

Arginine The amino acid arginine can promote nitric oxide synthesis, an important antibacterial component of the immune system. Studies have shown that supplementation with arginine can protect against bacterial infections as well as promote wound healing (4-6).

Zinc Zinc supplementation promotes immune function. Zinc can also enhance antiseptic agents used for cellulitis wound dressings (6).

Oregano Oil Oil of oregano has been used for conditions of inflammation, infection, indigestion, dysentery, and jaundice. Oregano oil is a powerful antiseptic and potent antibacterial, and has been used as an alternative to antibiotics (8). Rosmarinic acid, an active ingredient in oregano, may reduce inflammation (9). Other active ingredients, including thymol and carvacrol, have been shown to kill bacterial microorganisms (10).

Lactoferrin Lactoferrin, a natural peptide found throughout the body, has been reported to have antimicrobial, probiotic, and immune-enhancing properties. Studies have found that lactoferrin’s natural antibiotic properties can inhibit a wide range of bacteria, yeasts, and intestinal parasites (11-14). Since antibiotics are used in cellulitis treatment and often destroy friendly bacteria in the intestinal tract, lactoferrin’s probiotic properties are particularly helpful for enhancing intestinal tract immunity and insuring healthy intestinal microflora (14, 15).

Probiotics (Lactobacillus acidophilus and Bifidobacteria) Probiotics including lactobacillus acidophilus and bifidobacteria are nutritional supplements containing the same beneficial bacteria that are found in the digestive tract. As mentioned, antibiotics are used in cellulitis treatment. These drugs, however, often destroy friendly bacteria in the intestinal tract. The dietary supplementation of probiotics may be particularly helpful for insuring the regeneration of such “friendly” bacteria. (16).


1. Cellulitis statistics: http://content.nhiondemand.com/dse/consumer/HC2.asp?objID=100441&cType=hc

2. Maurer HR. Bromelain: biochemistry, pharmacology and medical use. Cell Mol Life Sci. 2001 Aug;58(9):1234-45.

3. Chandler, D.S., Mynott, T.L. Bromelain protects piglets from diarrhoea caused by oral challenge with K88 positive enterotoxigenic Escherichia coli. Gut 1998; 43(2): 196-202.

4. Wang, D., Wei, J., Hsu, K., Jau, J., Lieu, M.W., Chao, T.J., Chen, H.I. Effects of nitric oxide synthase inhibitors on systemic hypotension, cytokines and inducible nitric oxide synthase expression and lung injury following endotoxin administration in rats. J. Biomed. Sci. 1999 Jan; 6(1): 28-35.

5. Kirk, S.J., Hurson, M., Regan, M.C. et al. Arginine stimulates wound healing and immune function in elderly human beings. Surgery 1993 Aug; 114(2):155-9; discussion, 160.

6 Baligan M, Giardina A, Giovannini G, et al. L-arginine and immunity. Study of pediatric subjects. Minerva Pediatr. Nov1997;49(11):537-42.

7. Zeelie, J.J., McCarthy, T.J. Effects of copper and zinc ions on the germicidal properties of two popular pharmaceutical antiseptic agents, cetylpyridinium chloride and povidone-iodine. Analyst 1998; 123(3): 503-7.

8. Dorman HJ, et al. Antimicrobial agents from plants: antibacterial activity of plant volatile oils. J Appl Microbiol. Feb2000;88(2):308-16.

9. Lamaison JL, et al. Medicinal Lamiaceae with antioxidant properties, a potential source of rosmarinic acid. Pharm Acta Helv. 1991;66(7):185-8.

10. Marino, M., Bersani, C., Comi, G. Impedance measurements to study the antimicrobial activity of essential oils from Lamiaceae and Compositae. Int. J. Food Microbiol. 2001 Aug 5; 67(3): 187-95.

11. Bhimani, R.S., Vendrov, Y., Furmanski, P. Influence of lactoferrin feeding and injection against systemic staphylococcal infections in mice. J. Appl. Microbiol. 1999 Jan; 86(1): 135-44.

12. Dial, E.J., Hall, L.R., Serna, H., Romero, J.J., Fox, J.G., Lichtenberger, L.M. Antibiotic properties of bovine lactoferrin on Helicobacter pylori. Dig. Dis. Sci. 1998 Dec; 43(12): 2750-6.

13. Haversen, L.A., Engberg, I., Baltzer, L., Dolphin, G., Hanson, L.A., Mattsby-Baltzer, Human lactoferrin and peptides derived from a surface-exposed helical region reduce experimental Escherichia coli urinary tract infection in mice. Infect. Immun. 2000 Oct; 68(10): 5816-23.

14. Kuwata, H., Yip, T.T., Tomita, M., Hutchens, T.W. Direct evidence of the generation in human stomach of an antimicrobial peptide domain (lactoferricin) from ingested lactoferrin. Biochim. Biophys. Acta 1998 Dec 8; 1429(1): 129-41.

15. Kruzel, M.L., Harari, Y., Chen, C.Y., Castro, G.A. The gut. A key metabolic organ protected by lactoferrin during experimental systemic inflammation in mice. Adv. Exp. Med. Biol. 1998; 443: 167-73.

16. Saavedra, J.M. Clinical applications of probiotic agents. Am. J. Clin. Nutr. 2001 Jun; 73(6): 1147S-1151S.

17. Merck Manual eds, The Merck Manual of Diagnosis and Therapy, (Rahway,NJ: Merck & Co., Inc, 1997).

18. Life Extension eds., Disease Prevention and Treatment, 4th ed. Florida: Life Extension Media, 2003.


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