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What Is Bullous Cellulitis and How to Cure It

Bullous cellulitis is an infection in the deeper layers of the skin. It must be treated to prevent it from becoming severe.

Woman touching her leg in a bathroom, showing that bullous cellulitis can start on the leg.

The surface of your skin is home to otherwise harmless microbes. However, you may risk getting bullous cellulitis if germs somehow enter the deeper layers of your skin. The key is to address an infection as soon as possible.

Fortunately, a quick round of antibiotics, symptom management, and Traditional Chinese Medicine (TCM) can cure the infection. Learn more about bullous cellulitis and how to treat it. 

Symptoms, Causes, and Risk Factors of Bullous Cellulitis 

The bacteria usually responsible for bullous cellulitis include group A beta-haemolytic streptococci and staphylococcus aureus. Infection happens through a direct pathway paved by a crack in the skin and subsequent exposure to the bacteria. For example, you can develop cellulitis by getting a cut, crack, or scratch on your foot while walking through contaminated flood water.

A man‘s leg suffering from cellulitis.
Bullous cellulitis is caused by a bacterial infection in the inner layers of the skin.

Symptoms of bullous cellulitis include erythema (redness) with an ill-defined boundary, oedema (swelling), tenderness, pain, warmth, and blisters. These blisters are called bullae, an immune system response to protect damaged tissue while it heals. In some cases, a patient can develop a fever and fatigue as the body tries to fight the infection. 

You’d be at risk if you have an existing skin condition that causes cracks, such as eczema, psoriasis, or athlete’s foot. A weakened immune system or conditions that cause wounds to heal slowly, such as diabetes, are also risk factors. Being overweight also increases the risk of developing cellulitis. 

Treatment Options for Bullous Cellulitis 

The conventional and first line of treatment for bullous cellulitis is antibiotics. Your doctor will identify the category of bacteria the infection falls under and the specific antibiotic to prescribe.

Here are some suggestions for symptom management at home and TCM options to consider.

Symptom management and infection control 

Elevate the infected limb to prevent blood and fluids pooling at the site. A cool compress helps soothe the inflammation, while compression garments help with oedema. You may consider a painkiller such as paracetamol or ibuprofen to control fever and pain.

Rest while maintaining nutrition and hydration to help your body fight the infection. Wash your hands and sanitise surfaces you’ve touched. Also, avoid going into hot tubs, swimming pools and other shared bodies of water to prevent infecting others. 

TCM herbal regimen for inflammatory skin infections

Harvested angelica sinensis roots tied into bunches.
Angelica sinensis root (dang gui wei, 当归尾) is often found in formulas with invigorating properties that treat infections such as bullous cellulitis.

TCM physician Lim Sock Ling explains that bullous cellulitis is considered a yong (痈) in Chinese medicine or a cluster of boils formed under the skin. The three main syndromes that cause the boils are: 

  • Accumulation of Fire and toxins 
  • An exuberance of Heat with damage to the flesh 
  • Qi (vital life force) and Blood Deficiency 

Xian Fang Huo Ming Yin (仙方活命饮) is a TCM formula that clears Heat as well as removes toxins and Stasis earlier in the infection. In 2017, researchers in China published the results of a study on Xian Fang Huo Ming Yin and rheumatoid arthritis. Using animal models, they found that the formula works through immune-regulating properties, significantly improving inflammation. 

If the infection further develops into prickly pain with increased redness and warmth, a TCM physician may add Wu Wei Xiao Du Yin (五味消毒饮). “This combination of formulas aims to harmonise yin (warm channels, 阴), clear Heat, promote pus discharge and therefore purge toxins,” Physician Lim explains. 

Finally, TCM views this as Qi and Blood Deficiency in cases where the infection is prolonged. Blisters or bullae remain, indicating the damaged tissue is still trying to heal. “In this case, the goal would be to invigorate qi, nourish blood, purge toxins, and promote wound recovery,” advises Physician Lim.

She recommends Tuo Li Xiao Du powder (托里消毒散). In 2016, the Journal of Diabetes Research published evidence of this powder’s efficacy in animal models. The formula accelerated diabetic wound healing, as well as improved the healing quality.

“Those with a weak digestive system should consume the formulae cautiously. It’s best to seek a professional’s advice as consuming the cooling herbs may further weaken their digestion,” says Physician Lim. 

Combine TCM herbs with acupuncture 

Acupuncture can support Heat clearing and toxin removal, as well as help with pain relief. To remove Heat from the large intestine and Lung meridians (the areas invaded by pathogenic Heat), try massaging these acupoints: 

  • He gu (LI4, 合谷) 
  • Shou san li (LI10, 手三里) 
  • Nei ting (ST44, 內庭) 
  • Shang yang (LI1, 商阳) 

The shao yang (阳) meridian is a good area to work on. Meanwhile, to nourish Kidney yin (cool energy) to help clear Deficient Heat, massage the tai xi (KI3, 太溪) acupoint. 

Physician Lim cautions that acupuncture should not be administered at the infection site. This could further stimulate the infection, which can incur more pain and potentially lead to more widespread infection. If you have diabetes or are on blood thinning medicine, you should undergo acupuncture with caution. 

With prompt and proper treatment, symptoms of bullous cellulitis can be eased within 10 to 14 days. The key is to address the condition at the earliest sign of infection. Of course, prevention is always better, so maintain good health, hygiene, and balance to decrease the risk.

References

  1. MyHEALTH, Ministry of Health, Malaysia. 2019. Cellulitis. [online] Available at: <http://www.myhealth.gov.my/en/cellulitis/> [Accessed 30 October 2022]
  2. Malaysian Family Physician. 2020. The risk factors of lower limb cellulitis: A case-control study in a tertiary centre. [online] Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7136668/> [Accessed 30 October 2022]
  3. NHS Inform, Scotland, United Kingdom. Blisters. [online] Available at: <https://www.nhsinform.scot/illnesses-and-conditions/injuries/skin-injuries/blisters/> [Accessed 30 October 2022]
  4. StatPearls. 2022. Cellulitis. [online] Available at: <https://www.ncbi.nlm.nih.gov/books/NBK549770/> [Accessed 30 October 2022]
  5. Centers for Disease Control and Prevention (CDC), USA. 2022. Cellulitis: All You Need to Know. [online] Available at: <https://www.cdc.gov/groupastrep/diseases-public/Cellulitis.html> [Accessed 30 October 2022]
  6. Cleveland Clinic. 2022. Cellulitis. [online] Available at: <https://my.clevelandclinic.org/health/diseases/15071-cellulitis> [Accessed 30 October 2022]
  7. Streptococcus pyogenes: Basic Biology to Clinical Manifestations. 2016. Impetigo, Erysipelas and Cellulitis. [online] Available at: <https://www.ncbi.nlm.nih.gov/books/NBK333408/> [Accessed 30 October 2022]
  8. BMC Complementary Medicine and Therapies. 2017. Herbal formula Xian-Fang-Huo-Ming-Yin regulates differentiation of lymphocytes and production of pro-inflammatory cytokines in collagen-induced arthritis mice. [online] Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5216578/> [Accessed 30 October 2022]
  9. Journal of Diabetes Research. 2016. The Four-Herb Chinese Medicine Formula Tuo-Li-Xiao-Du-San Accelerates Cutaneous Wound Healing in Streptozotocin-Induced Diabetic Rats through Reducing Inflammation and Increasing Angiogenesis. [online] Available at: <https://www.hindawi.com/journals/jdr/2016/5639129/> [Accessed 30 October 2022]

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Reviews (1)

ShandaSep 16 2023

The pressure point massage points for releasing heat was an eye opener. I received a burn on inner calf which blistered and burst in several spots. It healed well with natural wildflower honey, gauze, and after first week, hydrogen patches to cover first. Then…overnight…it all turned a ripe tomato red. Hoping this natural remedy helps. Always my first choice! Anyone has any other tips I would gladly appreciate your kindness.
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