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  • Brindley Brooks

Cellulitis: When Should I Worry?

When should I start to worry about my abscesses? This article will help you determine the difference between a regular Hidradenitis Suppurativa abscess with normal inflammation and cellulitis (infection), which requires immediate medical attention.

First and foremost, always listen to your body; if something feels “out of the norm” for you with your HS, or just doesn't seem right, use that as a good indicator something may require more attention.

What is Cellulitis?

Cellulitis is a secondary complication of HS. It is a bacterial infection of the dermis, the deep layer of skin, as well as the subcutaneous tissues, the fat and soft tissue layer that are under the skin. Systemic antibiotics, oral antibiotics, or in severe cases, intravenous antibiotics are needed to treat cellulitis. Since cellulitis affects the deeper layers of skin and tissue, topical antibiotic ointments are not effective at treating it. Cellulitis that goes untreated can spread quickly to the lymph nodes and the bloodstream which is called Sepsis. Once you’ve had cellulitis you’re at a higher risk of developing it again.

Even if you’re currently on antibiotics, you can still develop cellulitis.

Why to Take Cellulitis Seriously

Sepsis, or a blood infection, is a more serious complication that can arise from cellulitis and is a life-threatening medical emergency. Read more about sepsis here.

Not Every Abscess is Cellulitis

Cellulitis is common for HS patients, however, not every abscess is cellulitis. HS naturally creates pain, redness, inflammation and swelling. Please pay attention to your body and your personal experiences with your HS.

Symptoms of Cellulitis

Pain: With cellulitis, the pain is typically much more intense than it is with your typical flares; intense throbbing, stabbing or stinging. Many say they've never felt anything like this before with their HS, which is a good indication that it needs to be looked at.

Tenderness: Typically much more tender than a normal abscess; sometimes even the air can be painful.

Increased Warmth: Many of our abscesses are warm to the touch. With cellulitis or any type of infection there is an increased warmth, almost hot to the touch.

Redness and Swelling: Again, this is normal for us with HS, however, if you follow the instructions above by drawing a circle and watching the redness to see if it spreads, this will help guide you. This is different than a typical HS flare.

Fever: Many of us have low-grade fevers (under 100) with flares normally. Anything above 99.9 should be regarded for potential cellulitis. There are some who don’t experience fevers (even low grade) with a flare. If you don’t typically experience a fever and have one with an abscess where you’re questioning as cellulitis, that would be an indicator to seek medical attention.

Note: Sometimes there is no fever at all with cellulitis. As a matter of fact, with cellulitis and other infections, your body temperature can drop to low levels, which is why being aware of your body’s typical HS reaction is so important.

Other Things to Watch Out For:

  • Flu like symptoms

  • Chills

  • Rapid heartbeat

  • Nausea

  • Vomiting

  • Feeling disoriented

How to Monitor Yourself for Cellulitis

HS patients are at higher risk of developing cellulitis and other skin infections, however, this does not mean that every abscess is going to turn into cellulitis.

We all know that HS abscesses come with a lot of pain and a lot of inflammation, meaning there will be redness around our abscesses, however, inflammation does not typically spread too far away from the abscess and surrounding area, nor does it spread quickly. Cellulitis type redness does spread quickly and further away from the abscess, cellulitis can also cause red streaking.

The best way to monitor the inflamed area(s) for redness growth is to gently draw a circle around the swollen area of skin using a felt-tip marker, which is more comfortable than a ball-point pen. You will then check the circle and skin every one to two hours; if the inflammation and redness has grown beyond the circle you drew, (especially if it grows quickly), that is an indication that you need to seek immediate medical attention.

As it’s been asked multiple times regarding those with darker skin: Follow the exact same concept above noting any changes in the color of your skin.


When you have a disease like HS it helps to keep a journal regarding how your abscesses act and behave. This can be the same journal you use to figure out what your triggers are, what food do you eat, etc. This journal will be of assistance when you are trying to determine if you should go to the hospital to be seen for cellulitis or not. Journaling will help you learn your body and your condition better; get in the habit of watching every single abscess, how they behave, feelings associated with them, redness, heat, etc. If necessary or if there are any questions, draw a circle around every single abscess (as noted above) until you understand more of how they work.


The second and third picture below were graciously donated by a member of the HS community. This was an abscess (where are the bandages is). The redness spread within a couple of hours, very quickly. You can see how far the redness can spread with cellulitis. Regular inflammation does NOT spread this far away from the abscess.


Read more about sepsis here.

Content in this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking treatment because of something you have read on this website.

Written by Denise Panter-Fixsen

Edited by Brindley Kons


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