Cellulitis: Scrotal, Lymphedema, Perineal: Symptoms, Causes, Treatment

Cellulitis is a potentially dangerous bacterial infection that affects superficial and soft tissues of skin. It mostly is caused by staphylococcus and streptococcus bacteria. Both males and females can be affected. In most cases, the infection develops in the lower legs, face and arms. Scrotal, lymphedema and perineal cellulitis can also occur.

Symptoms appear superficially and systematically. They begin with the affected skin becoming red and swollen. If not treated, general signs of spreading infection may manifest. Such signs include fever and chills.

A localized cellulitis infection is not that dangerous. It becomes deadly once infection has spread into the blood and other body parts, or causes necrosis. The good thing is that treatment options are available. In fact, more than 90% of all patients recover fully without complications of cellulitis. This is as long as treatment is done early enough and in the right manner.

Scrotal cellulitis causes, symptoms and treatments

Scrotal cellulitis is usually very painful and may spread to the penis or perirectal area. It often spreads fast.


Cellulitis of the scrotum is often caused by streptococcus bacteria. Unlike staphylococcus, these bacteria do not require a broken part of skin to reach soft skin tissues. They travel through blood from other infected areas. Common infections caused by hemolytic bacteria responsible for scrotal cellulitis include tonsillopharyngitis, pneumonia and otitis media. In most cases, infections in the upper respiratory tract cause orbital cellulitis symptoms, or cellulitis lip/facial infections.

Regardless, cellulitis on the scrotum can also result from a wound, ulcer or any other form of skin injury. Insect bites/stings and surgery are other examples of bacteria sources.


Swelling is the main sign of cellulitis, including scrotal cellulitis. It is caused by accumulation of fluid between skin layers located at the root of penis. The swelling is so intense that it blocks blood supply to penile and scrotal skin. This can lead to death of the affected skin or gangrene.

There also will be signs of redness, warmth and tenderness. The problem is that these signs may not be easily noticeable due to location of infection. Without treatment, systematic symptoms such as fever, chills, headaches and diarrhea may develop.

Diagnosis and treatment

Diagnosis is often required to rule out other possible causes of infection. It also helps confirm the nature of pathogen causing infection. Diagnosis can be done by physically examining the patient, taking blood test, using mass /fluid cultures or with imaging tests. Pictures taken with imaging tests such as MRIs are particularly important before removing collected fluid.

Treatment is done with surgery and antibiotics. Surgical incision is done to drain accumulated fluid. This is very important if gangrene is to be prevented. A needle and syringe may used as an alternative.

Antibiotics are medications that fight bacteria. Amoxicillin for cellulitis is a good example. Strep bacteria have a tendency to spread very rapidly. If not treated with antibiotics, they may cause death to fat tissue on the scrotum. Oral medicines are used in most cases. If the infection is unresponsive, IV antibiotics will be given.

Lymphedema cellulitis causes, symptoms, treatments and prevention

Lymphedema cellulitis occurs when severe cellulitis infection causes damage to the lymphatic system. This results in the condition known as lymphedema.

What is lymphedema?

Lymphedema is derived from two words, lymph and edema. Lymph fluid is the fluid that circulates throughout the body, picking waste materials and pathogens. These are then filtered by the lymph nodes and removed appropriately. Like blood, lymph fluid circulates through vessels. Obstruction or damage to these vessels may make it difficult for lymph fluid to circulate normally. This leads to accumulation of the fluid mostly in lower legs due to gravity. Edema is the clinical term for swelling.

Cellulitis and lymphedema

Cellulitis develops in tissues of skin located beneath the epidermis. It is for this reason that cellulitis is not contagious like other bacterial conditions. So is cellulitis contagious? Since the epidermis sits on top of the bacteria colony causing infection, the condition cannot be passed through direct contact. As a localized infection confined to the skin, cellulitis doesn’t cause or encourage lymphedema. Problems set in when infection spreads to the lymphatic system.

As mentioned earlier, it is the work of the lymphatic system to collect pathogens from their colonies and direct them to lymph nodes where they can be eliminated. But it doesn’t always work that easily. Infection can develop in the lymphatic nodes or vessels themselves. Resulting necrosis can severely damage the system such that it is unable to efficiently circulate lymph fluid throughout the body. When that happens, lymphedema will have developed.


Lymphedema is characterized by chronic swelling. The swelling is usually more noticeable on the lower legs. It may also occur in the arms, chest and head.

Cellulitis is characterized by swelling and redness. Mostly, there will be evidence of a recent injury on the skin. This is however not always the case. Strep bacteria can travel through blood to different parts of the body. This is commonly seen in orbital cellulitis where a sinus infection extends to eyes.

Once infection has spread to the lymphatic system, symptoms such as swollen lymph nodes, fever, chills, diarrhea, headaches may develop. Swollen areas may also develop dark marks which indicate necrosis.


Lymphedema is not curable. Like other such conditions, treatment aims at managing the condition rather than curing it. Treatment options include:

  • Exercises – light exercises encourage circulation of lymph fluid that has accumulated in certain body areas. Strenuous activities such as walking for long should be avoided since they increase swelling.
  • Massage – there are some massage techniques that may succeed in moving lymphatic fluid towards lymph nodes. A massage therapist specialized in these techniques can be approached for help.
  • Bandaging – compressing muscles around swollen areas may help reduce the swelling. This can be done with special types of bandages or with tight clothing. A professional should be approached before application.
  • Surgery – surgery doesn’t produce very good results. Nowadays, doctors are using surgery to remove some fat in severely swollen areas.

Cellulitis treatment is done with antibiotics. In most cases, oral medicines to be taken for 7-10 days are given. Severe infections may require IV antibiotics. In this case, patients will be treated in the hospital for few days.

Prevention measures for cellulitis revolve around keeping wounds from becoming infected. Unless bacteria reach soft tissues, cellulitis cannot develop. Open wounds should be kept clean, dry and bandaged. You can also try home treatments such as elevating areas above the heart to encourage lymphatic fluid flow. Other home treatments that may help include warm compress, resting and use of remedies like tea tree oil. Home remedies are particularly helpful in treatment for cellulitis in the leg.

Perineal cellulitis causes, symptoms and treatments

Perineal cellulitis is an infection that causes inflammation in fat tissue of the skin between the pubic arch and tail bone. It can be localized or extend from perianal cellulitis. This type of cellulitis can be a source of much discomfort and pain.


The main cause of perineal cellulitis is bacteria. Sources of bacteria include:

  • Other infections
  • Skin injuries
  • Insect bites/stings
  • Surgeries

For bacteria to cause cellulitis, they have to reach the soft tissues of the skin. It is for this reason that signs of cellulitis first show up around a recently injured area of the skin. However, some bacteria types can spread from other infections. This means that cellulitis can develop with signs of recent injury. This type of cellulitis spreads much more quickly.

Factors such as poor hygiene, a weak immune system, humid weather and skin conditions like eczema are considered risk factors. Risk factors do not necessarily cause a disease but make it more likely to develop.


Early symptoms occur on the perineal area. They include redness, warmth, swelling and tenderness. The area may also feel tightened and hardened. Sometimes, patients will experience signs of infections such as sore throat or tonsillitis prior to a perineal infection. In this case, there will be no injured skin area.

Due to accumulation of fluid in a pocket between skin layers in the perineal area, patients may experience signs of gangrene. This is where some muscles or tissues don’t get enough blood supply. This results in color changes, numbness and death of tissue.

If infection extends to the anus, symptoms may include:

  • Blood stained stool
  • Itchiness
  • Pain during bowel movements

Diagnosis and treatment

Diagnosis is done by reviewing the patient’s medical history and symptoms. For confirmation, the following tests may be ordered:

  • Blood test – reveals the number of white blood cells in blood. During infections, more white blood cells are produced.
  • Cultures – mass or fluid cultures may be taken. They help rule out conditions such as eczema, psoriasis and yeast infections. All of these are not bacterial.
  • Imaging tests – pictures may be taken with x-rays, MRIs or CT scans. This is especially if surgery is required during treatment. Pictures may also be used to rule out physical injuries, such as cases of cellulitis elbow.

To remove accumulated fluid and any dead tissue, surgery has to be done. Doctors sometimes drain accumulated fluid with a needle and syringe.

Cellulitis requires treatment with antibiotics. Most patients are treated with oral medicines, to be taken for 7-10 days. For severe infections, antibiotics will be given intravenously. Follow-up is necessary during treatment period. Sometimes, complications such as cellulitis sepsis can occur. This is where medications meant to treat cellulitis trigger inflammation all over the body.

When to see a doctor for cellulitis treatment

Removing cellulitis completely can be disappointingly hard. This is especially if the infection has spread. Use of topical agents and home treatments may mitigate symptoms but will not completely remove infection.

See your doctor if you suspect that you have contracted cellulitis. Patients who receive early treatment recover by the second day of using antibiotics such as Keflex for cellulitis. Regardless, medications should be taken according to guides provided by a doctor.

A potential cellulitis home remedy like tea tree oil or coconut oil may help but should not be used for complete treatment.

Note that cellulitis doesn’t always develop after a recent skin injury. It is for example possible for a tonsillar infection to spread to the lower body and cause scrotal cellulitis.