Hidradenitis suppurativa (HS, or acne inversa) is an inflammatory skin disease that can be painful enough on its own. When HS lesions and tunnels under the skin become infected with bacteria, the pain can be even worse. Bacterial infections within the skin are known as cellulitis, which has the potential to be extremely painful — and, in some cases, dangerous.

Here, we will explain what cellulitis is, how it can develop as a complication of HS, and how to tell a cellulitis infection from HS symptoms. As always, your dermatologist or health care provider is your best resource for diagnosing and treating skin conditions such as cellulitis.

What Causes Cellulitis With HS?

Cellulitis is most often caused by bacteria (often Staphylococcus and Streptococcus) entering the skin. Any break — even a tiny one — in the skin can lead to cellulitis. People with HS are at increased risk of cellulitis because they often have open sores on or near their abscesses, which can provide entry points for infection-causing bacteria.

Cellulitis infections go beyond the surface level of the skin. Tunnels (also known as sinus tracts), boils, and, abscesses associated with HS can provide bacteria the perfect opportunity to go deep into the skin and cause a serious infection.

What Does Cellulitis Feel Like With HS?

Members of myHSteam often describe their experiences with cellulitis and the pain it causes. One member wrote, “I’m in terrible pain, as I have an infected boil in my armpit and have now developed cellulitis. I’m currently on antibiotics and bathing three to four times a day. I hope it opens and drains soon.”

Cellulitis can become seriously debilitating and have negative effects on a person’s well-being and quality of life, especially when long-lasting or recurring. As one member explained, “I have severe folliculitis and cellulitis, which antibiotics aren’t clearing. Honestly, I’m at the end of my tether. I cannot cope.”

In severe cases, cellulitis can require admission to the hospital where doctors can provide stronger antibiotics and monitor the infection carefully. “About two years ago, I had a really bad ‘flare-up’ in my buttocks area that ended up bursting and sending me to the ER,” related one myHSteam member. “The doctors said it was cellulitis, and I was hospitalized for three days.”

If left untreated, cellulitis can lead to sepsis. This potentially life-threatening condition occurs when bacteria enter the bloodstream, causing an extensive bacterial infection throughout the body. Several myHSteam members have experienced sepsis firsthand. “I ended up in the hospital last week with cellulitis and sepsis due to HS,” shared one. “I had to be put on IV antibiotics! It was a scary experience.”

Symptoms of Cellulitis vs HS Symptoms

HS causes painful nodules in areas of the body with lots of hair follicles, such as the armpits (axillae) and genitals. Some symptoms of cellulitis and HS overlap, which can make it hard for a person with HS to tell whether or not they have cellulitis. Because HS already causes pain, swelling, redness or dark discoloration (depending on skin tone), inflammation, and skin tenderness, people with HS have to monitor their skin carefully and keep in mind what is normal for them.

People with HS should watch for several particular symptoms. It is important to consistently monitor any flare-ups, abscesses, or boils for any worsening or changes that might indicate cellulitis.

Ultimately, if something looks or feels more severe or painful than usual, it’s time to talk with your doctor. It’s always better to ask for help and not need it than to delay and potentially end up with a serious infection.

Read on to learn about the signs and symptoms of cellulitis. They include changes in skin and characteristics of infection.

Warm Skin

Although many people with HS experience abscesses and skin lesions that are warm to the touch, this heat will increase with cellulitis. The affected skin may feel hot or feverish.

Extremely Tender Skin

People diagnosed with HS experience painful cysts on their skin regularly, but areas with cellulitis will be even more tender than usual. It may feel impossible to wear even light clothing or feel minimal friction against the skin.

Streaks From the Affected Area

Cellulitis is often characterized by streaks of discoloration that seem to come from the painful, warm area. These streaks, which indicate that the body is trying to fight an infection, are not normally present with HS.

Swelling and Redness

People with HS are no strangers to swelling and discoloration. However, areas with cellulitis will be darker and more swollen than HS nodules. Doctors and dermatology experts recommend drawing a circle around a discolored, swollen area when it is first noticed. If the border of the affected area continues expanding beyond the circle, this may indicate an infection like cellulitis.

Fever

Although an elevated temperature is normal with HS flares, individuals with cellulitis often develop fevers, with a temperature of at least 100 degrees Fahrenheit. If your temperature is higher than it normally is with HS, it’s time to see a doctor or dermatologist.

How Is Cellulitis Treated?

If you suspect that you have cellulitis, discuss treatment options with your doctor or health care provider right away. Cellulitis can lead to potentially deadly conditions such as sepsis, so it’s crucial to seek professional medical treatment as soon as possible.

Antibiotics

Antibiotics provide the first line of defense against cellulitis. Your doctor may prescribe an antibiotic such as clindamycin or tetracycline, depending on a number of factors, which may involve culturing the bacteria that have invaded your skin. Note that topical treatments are not likely to help because cellulitis occurs in the deeper layers of the skin.

Sometimes, oral drugs are not enough. A person may need IV antibiotics to combat cellulitis effectively.

More and more frequently, doctors are seeing cellulitis caused by methicillin-resistant Staphylococcus aureus (MRSA), a more serious form of Staphylococcus bacteria. These infections can be much riskier and more difficult to treat, as they will resist most of the antibiotics that doctors can prescribe.

If you keep getting cellulitis, your doctor may recommend staying on suppressive antibiotics to help prevent infections.

Surgical Procedure

Surgery to treat cellulitis involves lancing and draining the wound, removing as much pus and damaged tissue as possible, and then packing the wound with antibacterial materials. Surgery is usually performed only when an infection affects a large area or does not respond to antibiotic treatment. Antibiotics are usually administered before and after surgery to help the body fight any remaining infection.

Treatment of Hidradenitis Suppurativa

HS can be difficult to treat. But if you can find an effective treatment strategy that keeps your HS symptoms in check, you may lower your risk factors for developing cellulitis. There are many different options for HS, and an experienced dermatologist can help you find what works for you, whether it’s hormone therapy such as oral contraceptives (birth control pill) or antiandrogens, a biologic like adalimumab (Humira) or infliximab (Remicade), or a retinoid like isotretinoin. Read more about different treatments for HS here.

Find Your HS Team Today

You’re not alone. On myHSteam, the social support network for people with hidradenitis suppurativa, you can ask questions, join conversations, and meet others who understand life with HS.

Have you developed cellulitis with HS? What did it feel like, and how was it treated? Share your experience or thoughts in the comments below or by posting on myHSteam.