Risk factors for cellulitis in patients with lymphedema

By: Lindsay Davey, MScPT, MSc, CDT
April 7, 2014
Editors: Ryan Davey, PhD and Lindsay Davey, MScPT, MSc, CDT

Severe bacterial infection called ‘cellulitis’ is common in people with lymphedema.  New clinical research suggests potential risk factors to avoid.

Cellulitis is a severe inflammation that is visible as red patches on the skin that may be swollen, hot, and painful to touch. Without treatment cellulitis can quickly become life-threatening in some cases.  If you believe you may have cellulitis you should see a doctor for treatment with antibiotics.  If you have an accompanying fever, if the infection appears to be getting worse, or has red streaks spreading out from it, you may have a very serious infection that requires immediate medical attention.

Cellulitis is caused by bacterial infection of the skin and underlying tissues. Cellulitis can arise from infection with a variety of bacteria, including those normally present on the skin. People with lymphedema are predisposed to cellulitis, and may develop it without having had any noticeable cut or break in the skin.  This predisposition is due to localized immune system depression arising from decreased lymph circulation – a key component in maintaining infection control.  People with lymphedema should learn how to monitor and prevent cellulitis.

Not everyone with lymphedema gets cellulitis.  A new study has examined the potential risk factors for developing cellulitis in patients with lymphedema.  It is the first case-controlled study performed to date investigating these risk factors (meaning that they used an experimental design that helps minimize the risk of drawing incorrect conclusions), and is thus the best data currently available.

179 cases of lymphedema patients with cellulitis were examined (along with 179 age and gender matched control subjects that had lymphedema but no cellulitis), and the authors identified independent risk factors for cellulitis.

Risk factors for cellulitis in patients with lymphedema

The latest research suggests that the length of time a patient has had lymphedema is not a risk factor for developing cellulitis. Diabetes was also not found to be a risk factor in this population (although diabetes is known to be a risk factor for cellulitis in the general population), nor was patient’s body mass index (BMI), or the presence of hypertension.

Not surprisingly, the more swelling patients had, the more likely they were to have developed cellulitis. Specifically, the percentage difference in limb circumference between a patient’s lymphedematous limb and unaffected limb was found to be a risk factor for developing the infection.  Interestingly, systolic blood pressure and fatty food and meat consumption also appeared to be risk factors for developing cellulitis.


In addition to careful monitoring and infection prevention strategies, the latest research suggests that by getting swelling under control, and by being mindful of high-fat food and meat consumption, people with lymphedema may decrease their probability of developing cellulitis.


  1. Teerachaisakul M., Ekataksin W., et al. Risk factors for cellulitis in patients with lymphedema: a case-controlled study. Lymphology. 2013 Sep;46(3):150-6.

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