Cellulitis in older adults

Cellulitis is an infection in deeper layers of skin. In later life, thinner skin, swelling in the legs, reduced sensation, poor mobility, or a small unnoticed crack can make an entry point easy to miss. The affected skin may be tender, hot, shiny, or increasingly swollen. Some older people may show a change in alertness, appetite, balance, or usual energy rather than a clear fever. Diabetes, circulation problems, and a history of recurrent skin breaks are useful details for the clinician. These factors do not diagnose cellulitis, but they can affect assessment and treatment planning.

Have a new or spreading red, warm, painful area assessed promptly, especially if the person has diabetes or reduced sensation. Marking the edge of redness with a pen and recording the time can help show whether it is spreading, but it should not delay care. Keep any wound gently clean and covered, avoid massage, and do not use unprescribed antibiotics. Bring a medicine list and note allergies, recent falls, ulcers, athlete's foot, or difficulty managing medicines. Follow the prescribed course and arrange review if symptoms are not settling.

Get urgent help if there is new confusion, unusual drowsiness, faintness, shaking, fast breathing, severe weakness, rapidly spreading redness, severe pain, or a high temperature. Swelling near the eye, breathing difficulty, or a person who cannot safely drink or take medicine also needs urgent evaluation. A serious body-wide response can develop, and sepsis requires emergency care.

Ask what may have allowed the infection to start, whether the person needs monitoring or a review appointment, how to protect fragile skin, and which changes in behaviour should trigger urgent help.