A spreading bacterial skin infection. Treatable with antibiotics, but one that needs watching closely from hour to hour.
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Cellulitis is a bacterial infection of the deeper layers of skin. It causes an area that is red, hot, swollen, tender and spreading, usually with fever and feeling unwell. It needs antibiotics, and it is one of the conditions where getting the diagnosis right matters in both directions.
The most useful thing on this page: cellulitis is almost always in one limb only. Redness affecting both lower legs is very rarely cellulitis — it is far more often venous eczema, chronic swelling or lipodermatosclerosis, which look similar and need entirely different treatment. A substantial proportion of "cellulitis" diagnoses turn out to be one of these, and repeated antibiotic courses do nothing for them.
And the practical tool that matters most: draw around the edge of the redness with a pen and write the date and time on it. That single act tells you and us, objectively, whether it is spreading or settling — which is far more reliable than trying to judge it by memory.
One emergency to recognise: pain that is severe and out of proportion to how the skin looks, spreading rapidly over hours, with purple or blistered skin or someone who is very unwell — that may be a deep, rapidly destructive infection needing immediate surgery. Call 999.
On brown and black skin the redness is much harder to see. Look instead for warmth, swelling, shininess and a change from the surrounding skin — cellulitis is diagnosed later and less often on darker skin for exactly this reason, and that delay matters.
Uncommon, and it must not be missed:
Cellulitis needs a break in the skin — and finding it matters, because leaving it untreated is why cellulitis recurs:
Worth knowing, because being treated repeatedly for the wrong thing is common:
Cellulitis is not contagious. You cannot pass it to anyone, and there is no need to isolate or avoid contact.
Cellulitis is diagnosed clinically, and clear, well-lit photographs help considerably — but this is one of the conditions where the limits of remote assessment are real, and we will say so.
Draw around the edge of the redness with a ballpoint pen and write the time and date beside it.
It is simple, and it is the single most useful piece of information available — it shows objectively whether the area is advancing, static or retreating, which decides whether treatment is working and whether you need to be in hospital.
We cannot examine you, feel the temperature of the skin, or assess how unwell you are in the way an in-person review does. Anyone who is systemically unwell, feverish, rapidly spreading, or has facial or eye involvement needs seeing in person, and we will arrange that rather than prescribing blind.
Full blood count and inflammatory markers where the picture is uncertain or the response to treatment is poor; HbA1c where diabetes has not been excluded, since it is both a risk factor and frequently undiagnosed at this point.
Usually flucloxacillin, or clarithromycin or doxycycline in penicillin allergy, for five to seven days. We can issue this same-day to your pharmacy where the picture is clear and you are otherwise well.
Expect the redness to look slightly worse for the first 24 to 48 hours before improving — that is normal as bacteria break down, and it is not a sign the antibiotic has failed. What matters is whether you feel better and whether the marked edge is advancing.
Raise the affected limb above the level of your heart whenever you can — for a leg, that means lying down with it propped on pillows, not sitting with it on a footstool.
Swelling holds infection in place and slows recovery. Elevation does as much as the antibiotic for how quickly it settles, and people are rarely told to take it seriously.
The step that prevents the next episode. Athlete's foot is the commonest way in, and treating it — properly, and for long enough — substantially reduces recurrence. Also: treat eczema, moisturise dry cracked skin, care for any ulcer.
Intravenous antibiotics for severe infection, sepsis, facial or eye involvement, rapidly spreading infection, frailty, or failure to respond to oral treatment. Suspected necrotising infection needs emergency surgery.
More than one episode in a year warrants a proper plan: treating athlete's foot and skin conditions, compression for chronic leg swelling — which is one of the most effective preventive measures — and, in some cases, long-term preventive antibiotics.
Call 999 immediately for:
Seek same-day medical assessment for:
Book an appointment for:
Recurrence is common, and largely preventable:
Chronic leg swelling is one of the strongest risk factors for recurrent cellulitis, and treating it is one of the most effective preventive measures available:
Check your feet daily, treat athlete's foot promptly, never use over-the-counter corn removers, and get any break in the skin looked at rather than waiting. The threshold for seeking help should be lower.
If both your lower legs are red and it has been going on for weeks or months without fever, it is probably not cellulitis — and repeated antibiotics will not help. Venous eczema and chronic swelling look similar and are treated with emollients and compression. It is worth asking the question directly if you have been round this loop before.
Your NHS GP treats cellulitis free, and flucloxacillin is one of the cheapest antibiotics available. NHS urgent care and hospital treatment are free where it is severe.
The free thing that matters most is a pen. Marking the edge of the redness and writing the date on the skin turns a vague impression into an objective measurement — spread beyond that line over the next day is the single most useful sign of whether treatment is working, and it is far more reliable than memory.
Elevation is the other free intervention and is consistently under-done. For a leg, that means genuinely raised above hip level for most of the day — not simply on a footstool. It reduces swelling substantially and speeds recovery.
Where a private consultation is genuinely useful is speed, since cellulitis worsens over hours rather than days, and a same-day photo assessment with a prescription is a real advantage over waiting.
The thing worth looking for that most services skip is the entry point. Athlete's foot between the toes is a very common and entirely treatable cause of recurrent leg cellulitis, and treating it prevents the next episode. So does managing swelling and skin care.
What needs urgent in-person care: fever with shivering, confusion, a rapidly advancing edge, or severe pain out of proportion to how the skin looks — which can indicate a deep, rapidly progressive infection and is an emergency.
NICE NG141, Cellulitis and erysipelas: antimicrobial prescribing, is the governing guideline. It recommends flucloxacillin as first-line, with clarithromycin, erythromycin or doxycycline in penicillin allergy, and covers when to refer for intravenous treatment.
NG141 recommends marking the extent of the infection to monitor progression — the basis for the point above.
NG141 sets out the criteria for hospital referral: systemic illness, rapidly deteriorating cellulitis, infection near the eyes or nose, suspected necrotising fasciitis, or lymphangitis.
NICE CKS, Cellulitis — acute, covers elevation, analgesia and the identification of predisposing factors including tinea pedis, lymphoedema, venous insufficiency and diabetes.
CKS recommends treating any underlying skin condition to reduce recurrence, and covers antibiotic prophylaxis for recurrent cellulitis.
Almost certainly not. Cellulitis is nearly always in one limb only. Redness in both lower legs, present for weeks or months without fever, is far more likely to be venous eczema, chronic swelling or lipodermatosclerosis — which look similar and are treated with emollients and compression rather than antibiotics. A substantial proportion of "cellulitis" turns out to be exactly this, and repeated antibiotic courses achieve nothing.
Draw around the edge of the redness with a pen and write the date and time. It gives an objective answer to the question that matters most — is it spreading? — and it is far more reliable than judging by memory. Take a photograph too.
That is usually expected. The redness can look slightly worse over the first 24 to 48 hours as bacteria break down, before improving. What matters is whether you feel better and whether the area is still advancing beyond your marked line. If it is spreading at 48 hours, or you feel worse, get reviewed.
More than most people are told — it does nearly as much as the antibiotic. Swelling holds infection in place and slows recovery. It needs to be above the level of your heart, which means lying down with the leg on pillows, not sitting with it on a footstool.
Usually two reasons, both fixable. An untreated entry point — most often athlete's foot, which is the commonest way in and the most overlooked. And chronic leg swelling, which is one of the strongest risk factors. Treating the feet properly, moisturising daily, and using compression stockings for swelling prevents a great many recurrences.
Pain far worse than the skin looks, spreading over hours rather than days, purple or blistered skin, or feeling seriously unwell. That combination can indicate a deep, rapidly destructive infection requiring immediate surgery. Sepsis signs — confusion, extreme shivering, mottled skin, passing no urine — are the other reason to call 999.
No. Cellulitis cannot be passed to anyone, and there is no need to isolate, avoid contact or keep a child off school. It is an infection of your own deeper skin, not something that spreads person to person.
An important question, because redness is much harder to see on brown and black skin, and cellulitis is consequently diagnosed later. Look for warmth compared with the other limb, swelling, shininess or tightness of the skin, and tenderness — and rely on how you feel, since fever and feeling unwell carry the same weight whatever your skin tone.
August 24, 2026
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It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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