December 2nd, 2009
Even though it has an innocuous name, cellulitis is a skin infection that should be taken very seriously. Avoid any confusion by knowing if and when massage therapy is safe to administer to a client with cellulitis.
by Nicole Cutler, L.Ac.
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Without a photographic memory, remembering all of the skin conditions learned in anatomy and pathology class can be challenging. After all, that’s what dermatologists are schooled in – and even this highly trained type of physician must rely on his or her references to ensure diagnostic accuracy. While massage therapists are not expected to be familiar with every type of skin disorder, cellulitis poses an exception. Unfortunately, clients are not always aware of the ailments they harbor or their severity. In these instances, bodyworkers must be able to recognize cellulitis and comprehend massage therapy’s potential benefits and dangers when working with this dangerous condition.
Cellulitis is a spreading bacterial infection of the skin and tissues beneath the skin. Often starting with a small area of tenderness, swelling and redness, a person with cellulitis typically develops a fever and chills as the reddened area enlarges. Without treatment, the fever can get very high. In addition, lymph nodes near the affected area commonly swell. Cellulitis is often associated with “tracking,” which is seen as streaks of red traveling away from the area of inflammation though lymphatic ducts towards the nearest group of lymph nodes.
Unlike a superficial skin infection, cellulitis refers to an infection also involving the skin’s deeper layers: the dermis and subcutaneous tissue. Although several different bacteria can be involved in cellulitis, streptococcus or Staphylococcus aureus are the pathogens predominantly responsible. Cellulitis most often affects the legs, but it may also occur on the arms, face and scalp.
In general, cellulitis can be cured with antibiotics. However, the development of antibiotic-resistant bacteria and the complications that are associated without treatment can make cellulitis life-threatening. In 50 to 60 percent of cases, the person has had some kind of recent skin injury such as a cut, insect bite, trauma, burn, surgical incision, intravenous catheter or dermatitis. While cellulitis may appear after an injury, it’s also been diagnosed in infants, adults and seniors who have recently recovered from strep throat.
If cellulitis is not treated on time, there can be several undesirable consequences. Although rare, complications of cellulitis can be serious and/or fatal, including abscesses, gangrene leading to limb loss, thrombophlebitis and sepsis.
Those with some of the following conditions are at higher risk for developing cellulitis:
- Chickenpox and shingles
- Fungal infections of the feet
- Peripheral vascular disease
- Contaminated wounds
- A weakened immune system
- Widespread infection
Cellulitis Treatment and Prevention
Because the infection can rapidly spread throughout the body, receiving conventional medical treatment as soon as possible is necessary for containing and eliminating cellulitis. The standard treatment for cellulitis revolves around antibiotics. In addition to antibiotic therapy, Western medicine advises elevating the affected area, minimizing movement and applying cool, wet, sterile bandages for comfort relief. If these steps are insufficient, hospitalization and intravenous antibiotics are inevitable. Sometimes, surgery is required to drain an underlying abscess.
Most complementary medical interventions, including massage therapy, are dangerous until all signs of a cellulitis infection have dissipated. Even though massage is usually only contraindicated locally for most skin infections, this does not apply to cellulitis. As a systemic infection, the bacteria may have gained access to the lymph nodes and bloodstream in cellulitis. Therefore, attempts at circulation enhancement can easily spread this dangerous infection.
On the other hand, massage therapy may act as a preventative for developing cellulitis. Especially beneficial to those at high risk for this kind of infection, or for someone who has had a previous experience with cellulitis, the regular application of bodywork can help protect people from developing this kind of skin infection. Since those with a history of circulation problems – whether caused by diabetes, lymphedema, peripheral vascular disease or a similar condition – are particularly vulnerable to developing cellulitis, these individuals can benefit most from prevention approaches. The following two tactics will help protect even the most susceptible people from developing cellulitis:
- Lymphatic Drainage Massage – By draining existing congestion and preventing fluid from accumulating in the lymphatic system, manual lymphatic drainage keeps the nodes clear to better remove potential cellulitis-causing pathogens.
- Acupressure – Although many types of massage can improve immunity, stimulating the acupressure points Stomach 36, Spleen 6, Large Intestine 11 and Triple Warmer 5 help strengthen the immune system to better remove bacterial threats.
Since this bacterial infection can invade both the lymphatic and circulatory systems, massage therapy is contraindicated until all signs of infection have passed. Hopefully, clients who have cellulitis will know the importance of canceling a massage appointment. If on antibiotics for this kind of infection or if the therapist suspects cellulitis, clients should either be at home resting, visiting their physician or in a hospital bed. Then again, for clients who are at risk for, but without signs of a cellulitis infection, bodywork and exercise give them an advantage over future bouts of this rapidly spreading, perilous, systemic infection.
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Puszko, Sharon, PhD, CMT, Jane Keegan, LPN, Working with Challenging Skin, Massage & Bodywork, August/September 2003
Werner, Ruth, LMP, A Massage Therapist’s Guide to Pathology, Lippincott, Williams and Wilkins, 2005.
www.medicinenet.com, Cellulitis, Melissa Conrad Stoppler, MD, MedicineNet, Inc., 2008.
www.umm.edu, Cellulitis, University of Maryland Medical Center, 2008.
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