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Cellulitis and Multiple Sclerosis: Do MS Treatments Raise the Risk?

Posted on May 17, 2022
Medically reviewed by
Evelyn O. Berman, M.D.
Article written by
Simi Burn, PharmD

Cellulitis is a type of skin infection caused by bacteria. Multiple sclerosis (MS) is an autoimmune disease in which the person’s immune system attacks the nerves in the brain and spinal cord. Because people with MS are at a higher risk of different kinds of infections in general, their risk of cellulitis is also increased.

MyMSTeam members have shared their experiences with cellulitis. One member said, “It’s a painful day due to cellulitis in both legs.” Another member said, “I just had my sixth bout of cellulitis. It had all the signs — red, raised surface, warm to the touch.” A third member replied, “I’ve had cellulitis once, and it cleared up with antibiotics. It was awful, but it cleared.”

One member wrote, “I’ve been having some bad days. I’ve developed cellulitis in both legs. Hopefully, a round of antibiotics will help!” Another member shared, “There is nothing quite like spending your birthday in the hospital with cellulitis! I’m waiting for one normal day.”

What Is Cellulitis?

Cellulitis is a common skin infection caused by bacteria. It is characterized by redness, swelling, warmth, and pain. The most common bacteria that causes cellulitis is group A Streptococcus, which lives on the skin and in the throat. It can affect anyone.

Does MS Increase the Risk of Cellulitis?

People with MS are generally at increased risk of having different kinds of infections, including cellulitis, as well as urinary tract infections and pneumonia.

The link between MS and infections like cellulitis is based on many factors related to a person’s health and medical conditions. The following are risk factors for cellulitis:

  • Injuries that cause a break in the skin (such as cuts, lesions, ulcers, pressure sores, animal or insect bites, and puncture wounds)
  • Recent surgery
  • Intravenous drug use
  • Immunosuppression, which is an impaired immune system due to a medical condition (such as diabetes or HIV) or medication (such as many MS treatments)
  • Chronic skin conditions (fungal infections and rashes)
  • Infections from viruses (chicken pox and shingles)
  • Swollen limbs ​​(feet, legs, hands, and arms)
  • Lymphedema, which is a lymphatic system drainage problem that is more common in people with MS
  • Previous removal of a vein

Do MS Treatments Increase the Risk of Cellulitis?

The main medications for MS target the immune system and suppress the parts of the immune response that attack the body’s nerves.

MS treatments can affect antibodies and immune system blood cells, lowering your body’s natural ability to fight off infection. Because medications used to treat MS are linked to an increased risk of many infections, these medications can increase the risk of cellulitis.

Is Cellulitis Related to MS Relapses?

For people living with MS, infections like cellulitis can also trigger a relapse.

Relapsing-remitting MS is the most common type of MS. In this kind of MS, there are relapses or flare-ups — periods of time when symptoms get worse. Relapses are followed by a period of remitting MS — when symptoms get better. Many people who have relapsing-remitting MS transition into secondary progressive MS. These individuals have fewer relapses or none at all, and the disease gradually gets worse over time.

Different infections can trigger MS relapses, such as upper respiratory infections like the common cold. If you have an infection, your risk of an MS relapse is higher around that time.

What Does Cellulitis Look and Feel Like?

Cellulitis is a red, swollen, painful, and warm area of the skin. The infection may appear around an existing wound. The redness can spread quickly and can appear streaky. If you have cellulitis, the affected skin may be extremely painful and warm or hot to the touch. The skin can look pitted like an orange peel. Sometimes, blisters can appear. People with cellulitis can have fever or chills and may feel generally unwell.

You can get cellulitis anywhere on the body, but it is more common on the feet and legs. It is not contagious.

How Is Cellulitis Diagnosed?

Most of the time, your doctor or health care professional will diagnose cellulitis by looking at your skin and performing a physical examination to check for fever and lymph node swelling. Usually, you don’t need a blood test or other labs to diagnose cellulitis.

How Is Cellulitis Treated?

Cellulitis is treated with antibiotics. Typically, your health care provider will prescribe an antibiotic that is taken by mouth. If the cellulitis is severe enough, they will prescribe intravenous antibiotics. Sometimes, wounds on the skin need to be treated directly, which may involve removing tissue, draining fluid or pus, and bandaging.

It’s important to practice good wound care and hygiene to prevent worsening of cellulitis and promote recovery. If cellulitis is in an arm or leg, your doctor may tell you to keep your limb elevated to reduce swelling and help the infection clear.

If cellulitis is not treated, it can quickly spread and cause serious health problems, such as infections in the blood, joints, bones, or heart. It could also turn into a more serious infection called necrotizing fasciitis, or flesh-eating disease. Make sure to follow up with your health care team if you have been diagnosed with cellulitis.

How Can You Reduce Your Risk of Cellulitis With MS?

People can get cellulitis more than once, and there is no vaccine to prevent this infection. However, staying up to date with your vaccinations can help you avoid other infections that can trigger a relapse.

If you have any cuts or injuries that break the skin, make sure to practice good hygiene, take care of the wound, and keep the area clean. These measures help to prevent a bacterial skin infection that might cause cellulitis. You can usually clean minor cuts and injuries with soap and water. As injuries are healing, make sure to check your skin for signs of redness, swelling, pain, or warmth that could indicate cellulitis. If you see any signs that infection is developing, see your health care provider right away.

Regular skin checks are important for people with impaired immune systems or conditions like diabetes and MS. Remember to inspect hard-to-see places like between the toes and the backs of the legs.

Make sure to wash your hands frequently with soap and water to prevent infection. Use an alcohol-based hand sanitizer when washing is not possible.

If you have an open wound or active infection, do not spend time in hot tubs, swimming pools, or natural bodies of water until it is healed.

Talk With Others Who Understand

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 186,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

Are you living with multiple sclerosis? Have you experienced cellulitis? Share your story in the comments below, or start a conversation by posting on your Activities page.

All updates must be accompanied by text or a picture.
Evelyn O. Berman, M.D. is a neurology and pediatric specialist and treats disorders of the brain in children. Review provided by VeriMed Healthcare Network. Learn more about her here.
Simi Burn, PharmD is a seasoned pharmacist with experience in long-term care, geriatrics, community pharmacy, management, herbal medicine, and holistic health.. Learn more about her here.

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