TREATING CELLULITIS: A HOLISTIC GUIDE TO MANUAL THERAPY, LYMPHATIC DRAINAGE, AND HERBAL MEDICINE by Gregory Lawton

TREATING CELLULITIS:

A HOLISTIC GUIDE TO MANUAL THERAPY, LYMPHATIC DRAINAGE, AND HERBAL MEDICINE

A Natural Non-Invasive Approach

ABSTRACT

Copyright 2024, Dr. Gregory T. Lawton All rights reserved. No part of this book shall be reproduced, stored in a retrieval system, or transmitted by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from Dr. Gregory T. Lawton. American Health Source, Inc. 2040 Raybrook SE, Suite 104 Grand Rapids, Michigan 49546 888-375-7245

Dr. Gregory T. Lawton

TREATING CELLULITIS: A HOLISTIC GUIDE TO MANUAL THERAPY, LYMPHATIC DRAINAGE, AND HERBAL MEDICINE

Introduction

The holistic treatment of cellulitis has been a constant aspect of my clinical practice over the last half century. Most patient cases that I have treated have involved patients who present with multiple illnesses and conditions including morbid obesity, diabetes, lymphedema, vascular insufficiency, congestive heart failure, heart disease, high blood pressure as well as serious pulmonary, liver, and kidney diseases.

Wherever possible I attempt to treat the whole person and the comorbid causes and underlying conditions that the patient presents with. Often, and in the most serious cases, the patient does not comply with my recommendations targeting the causes of their cellulitis.

In our advanced manual therapy training programs offered through the Blue Heron Academy and American Health Source, especially our lymphedema training program we address the most vital and essential aspects, techniques, and treatment protocols related to cellulitis. If may not be obvious, so it should be mentioned that when we talk about the treatment of cellulitis, we are discussing treating cellulitis in the non-infectious, medically stabilized recovery, or chronic recurrent phases.

In this booklet I am attempting to augment the information provided on this topic in my lymphedema training manual and our Homeosomatic Lymphedema Therapy certification program as well as our advanced training classes and workshops on this subject.

If you are treating or planning on treating infectious cellulitis in your practice, I recommend a good review of clinical hygiene and cross infection control procedures.

Cellulitis Throughout History

Throughout recorded history, herbal medicine has played a vital role in the treatment of skin infections, including conditions resembling cellulitis, long before the advent of modern antibiotics. Ancient herbalists, traditional healers, and early manual therapists understood the healing properties of plants and used them extensively to address inflammation, infection, and swelling. From the use of garlic, known for its potent antibacterial properties, to goldenseal, rich in berberine and widely applied for its ability to fight infection, herbal remedies have been staples in the care of skin conditions that modern medicine now identifies as cellulitis. In the ancient Greek and Roman eras, physicians like Hippocrates and Galen often turned to medicinal plants to cleanse wounds and reduce swelling, applying poultices of herbs like calendula and chamomile to soothe and heal irritated skin. Similarly, in traditional Chinese medicine (TCM) and Ayurveda, herbs such as turmeric, ginger, and gotu kola were prescribed for their antiinflammatory and immune-boosting properties to treat infections that likely included cellulitis.

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Throughout the Middle Ages and into more recent centuries, herbalists and traditional doctors continued to employ these time-honored remedies. They would combine manual therapies like lymphatic massage with herbal poultices and washes to treat festering wounds and swollen limbs. By using herbs with antimicrobial and astringent properties, they were able to manage skin infections effectively, drawing on plants like violet leaf and flowers, comfrey leaf, and plantain leaf to cleanse wounds and reduce inflammation. Manual therapists were often well versed in herbal medicine, integrating these treatments with hands-on techniques to help support the body’s natural healing processes. Long before antibiotics became the first line of defense, herbalists worked with the natural world to support the body’s immune response and reduce the risk of infection. Even today, in a world dominated by pharmaceuticals, many practitioners and patients alike find value in these ancient traditions, recognizing that herbs, when used thoughtfully, can offer powerful support in managing infections like cellulitis in conjunction with medical care and management.

What is Cellulitis?

Cellulitis is a common and sometimes serious bacterial skin infection that affects the deeper layers of the skin and the underlying tissue. It typically presents with symptoms of redness, swelling, warmth, and pain in the affected area, most commonly on the legs, though it can occur anywhere on the body. The infection is most often caused by bacteria such as Streptococcus and Staphylococcus, which enter through a break in the skin. Cellulitis progresses in stages, beginning with mild symptoms like localized redness and tenderness, which, if untreated, can escalate to more severe swelling, pain, and systemic symptoms like fever and chills. In advanced stages, cellulitis can spread rapidly and lead to complications such as abscess formation, tissue death, or even sepsis, making early and effective treatment crucial.

Cellulitis is typically staged based on the severity of the infection and the progression of symptoms, from mild to more advanced stages. In the early stage, cellulitis presents as localized redness, warmth, swelling, and tenderness in the affected area, often without systemic symptoms. The skin may feel tight, and there may be some mild discomfort, but at this point, the infection is usually limited to the superficial layers of the skin. As the condition progresses to a moderate stage, the area of redness and swelling expands, and the infection begins to penetrate deeper into the tissue. At this stage, patients may start to experience systemic symptoms such as fever, chills, and malaise, indicating that the body’s immune system is reacting more intensely to the infection. Blisters or pusfilled lesions may appear on the skin, and the pain in the affected area tends to increase.

In the severe stage of cellulitis, the infection can spread rapidly, affecting deeper layers of the skin and potentially spreading through the bloodstream or lymphatic system, leading to more serious complications. The skin may become dark red or purplish, indicating significant tissue involvement, and fever and other systemic symptoms become more pronounced. There may also be signs of sepsis, such as a high fever, low

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blood pressure, and rapid heart rate. Without prompt and aggressive medical treatment, severe cellulitis can lead to abscess formation, tissue necrosis, or even life-threatening septicemia. In the case of chronic or recurrent cellulitis, the infection may recur in the same areas due to underlying issues such as lymphedema, poor circulation, or diabetes, leading to long-term swelling, tissue damage, and a heightened risk of future infections. Staging cellulitis helps healthcare providers tailor their treatment approach, ranging from oral antibiotics in mild cases to hospitalization and intravenous antibiotics in severe cases.

Medical Approaches to Therapy

When cellulitis progresses to more serious stages, medical treatment becomes more aggressive to prevent complications such as abscess formation, tissue necrosis, or sepsis. In the case of moderate cellulitis, treatment typically involves oral antibiotics that are stronger or more broad-spectrum than those used in the early stages. Common antibiotics such as cephalexin, clindamycin, or amoxicillin-clavulanate are prescribed to target the bacteria most commonly associated with cellulitis, namely Streptococcus and Staphylococcus. Close monitoring is essential during this stage, as healthcare providers need to assess whether the infection is responding to treatment within the first 24 to 48 hours. If the infection does not improve or worsens, hospitalization may be necessary. In addition to antibiotics, pain and inflammation are managed with medications like ibuprofen or acetaminophen, along with supportive measures such as elevating the affected limb and applying cool compresses to reduce swelling.

For severe cellulitis, hospitalization and intravenous (IV) antibiotics are often required. This is especially important if the infection is spreading rapidly or if systemic symptoms such as fever, chills, or sepsis are present. Common IV antibiotics used in these cases include vancomycin, ceftriaxone, or piperacillin-tazobactam, which provide stronger and faster infection control. In cases where abscesses or necrosis occur, surgical intervention may be necessary. Incision and drainage procedures help remove infected fluid, while debridement is performed to remove dead tissue and prevent the spread of infection. If the infection leads to sepsis, which is life-threatening, additional supportive care such as intravenous fluids, oxygen therapy, and medications to stabilize blood pressure may be provided in an intensive care unit (ICU). Pain management becomes more crucial at this stage, with stronger prescription painkillers and medications being administered to manage discomfort and inflammation.

For individuals with chronic or recurrent cellulitis, long-term preventive measures are often implemented. Antibiotic prophylaxis, where low-dose antibiotics like penicillin or erythromycin are taken regularly, can help prevent future infections. Managing underlying conditions such as lymphedema, poor circulation, or diabetes is also critical in reducing the recurrence of cellulitis. This might involve the use of compression therapy to manage swelling or strict blood sugar control for diabetic patients. Education on proper skin care becomes an essential part of the treatment plan, as patients are instructed to keep their skin clean, moisturized, and free of any open wounds.

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Preventive strategies, such as wearing protective clothing, maintaining foot hygiene (particularly in diabetic patients), and avoiding skin trauma, can significantly reduce the risk of recurring cellulitis.

In cases where complications like abscesses develop, surgical drainage becomes necessary, followed by proper wound care to prevent further infection. Chronic damage to the lymphatic system caused by repeated infections may require post-recovery therapies such as manual lymphatic drainage (MLD) or compression bandaging to reduce ongoing swelling and prevent further episodes of cellulitis. Once the acute infection has been treated, healthcare providers continue to monitor the patient to ensure complete recovery and to address any lingering issues. Adjustments to the treatment plan may be required if the infection is slow to resolve or if complications persist. Ultimately, serious stages of cellulitis require prompt and aggressive medical intervention, including hospitalization, IV antibiotics, and sometimes surgery. Long-term management of underlying conditions, combined with patient education, is key to preventing future episodes and promoting full recovery.

Complications, Adverse Reactions, and Side Effects of Allopathic Treatments for Cellulitis

In medical circles the treatment of cellulitis with herbal medicine is discouraged while citing the risk of spreading infection, but what about common medical treatments for cellulitis with antibiotics or steroids, what about their side effects and risks?

In modern medicine, the underreporting of patient injuries, secondary infections, and deaths related to drug use, especially antibiotics and steroids, can be attributed to a combination of legal, institutional, and systemic factors. One of the primary reasons is the fear of legal consequences. Physicians and healthcare institutions may be reluctant to fully disclose adverse reactions to antibiotics or steroids, particularly if such incidents could lead to malpractice claims or lawsuits. The fear of reputational damage or financial loss can cause institutions to suppress or downplay the frequency of these complications.

In the case of antibiotics, overuse and misuse are well-documented concerns, leading to antibiotic resistance and secondary infections such as Clostridioides difficile (C. diff) infections. However, healthcare providers may underreport these adverse effects, as acknowledging widespread antibiotic misuse could raise questions about prescribing practices and contribute to public mistrust. Furthermore, secondary infections resulting from prolonged or inappropriate antibiotic use may be categorized as expected risks of treatment, making it easier to justify or downplay their occurrence.

Steroids, often used to reduce inflammation and manage chronic conditions, can have severe side effects, including immune suppression, which makes patients more vulnerable to infections. The use of steroids can mask underlying infections, leading to delays in diagnosis and more severe complications. Adverse outcomes associated with long-term steroid use, such as bone density loss or adrenal suppression, are sometimes

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not immediately attributed to the drug itself, complicating reporting. Additionally, the culture within medicine often reframes adverse effects of steroids as necessary risks in managing severe diseases, further minimizing their impact in official reporting.

Antibiotics and other drugs used to treat cellulitis, especially in its more severe stages, can have side effects and potential complications. The severity and type of side effects depend on the specific drug used, the dosage, and the individual’s overall health. Below are some common side effects and complications associated with the antibiotics and drugs used to treat cellulitis:

Antibiotics (Oral and Intravenous)

Cephalexin (Keflex), Amoxicillin-Clavulanate (Augmentin), Clindamycin:

These antibiotics are commonly used to treat mild to moderate cellulitis. Their side effects include:

Gastrointestinal Issues: The most common side effects are nausea, vomiting, diarrhea, stomach cramps, and loss of appetite. These issues can range from mild to severe and sometimes lead to dehydration.

Allergic Reactions: Some individuals may experience allergic reactions, which can range from a mild rash or itching to more serious reactions like anaphylaxis, which requires immediate medical attention.

C. difficile Infection: Antibiotics, especially broad-spectrum ones, can disrupt the normal gut flora, leading to an overgrowth of Clostridioides difficile (C. diff), which can cause severe diarrhea, abdominal pain, and potentially life-threatening colitis

Vaginal Yeast Infections: Antibiotic use can disrupt the balance of bacteria in the body, potentially leading to yeast infections, particularly in women.

Vancomycin (IV Antibiotic for Severe Cellulitis):

Vancomycin is used to treat more resistant infections or severe cases of cellulitis. Common side effects include:

Red Man Syndrome: This is a unique reaction to vancomycin, causing symptoms like flushing, redness, rash, and itching, often starting on the upper body and head. It is not a true allergy but is related to the rate of infusion and can be controlled by slowing down the IV administration.

Kidney Toxicity (Nephrotoxicity): Vancomycin can cause kidney damage, particularly in patients with pre-existing kidney conditions or those on high doses. Regular monitoring of kidney function is necessary.

Ototoxicity: Vancomycin can also lead to hearing damage (ototoxicity), although this is less common and usually occurs in patients receiving high doses for a prolonged period.

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Ceftriaxone (IV Antibiotic):

This antibiotic is commonly used for severe infections like cellulitis and carries the following side effects:

Injection Site Reactions: Patients may experience pain, swelling, or redness at the injection site.

Liver Function Issues: Prolonged use may affect liver function, leading to abnormal liver enzymes.

Allergic Reactions: As with other antibiotics, there is a risk of allergic reactions, ranging from rash to anaphylaxis.

Piperacillin-Tazobactam (Zosyn):

This is a broad-spectrum IV antibiotic used for severe cellulitis cases. Side effects include:

Electrolyte Imbalance: Piperacillin-tazobactam can cause imbalances in electrolytes, such as low potassium levels (hypokalemia), which may need to be monitored and managed during treatment.

Kidney Dysfunction: Like vancomycin, it can potentially damage the kidneys, especially with prolonged use or in patients with pre-existing kidney conditions.

Painkillers and Anti-inflammatory Drugs

Ibuprofen and Acetaminophen (Tylenol):

These drugs are used to manage pain and inflammation associated with cellulitis, especially during severe stages. While generally considered safe when taken as directed, they can have side effects:

Gastrointestinal Issues: Ibuprofen, especially when taken long-term, can irritate the stomach lining, leading to stomach pain, ulcers, or gastrointestinal bleeding.

Liver Damage: High doses of acetaminophen can cause liver damage, particularly if taken over a prolonged period or when combined with alcohol.

Kidney Damage: Chronic use of ibuprofen can contribute to kidney damage, especially in patients with pre-existing kidney conditions.

Prescription Painkillers (Opioids):

For severe cellulitis cases where pain is intense, doctors may prescribe opioids such as hydrocodone or oxycodone. These carry significant risks, including:

Addiction: Opioids have a high potential for dependence and addiction, even when taken as prescribed for a short period.

Respiratory Depression: Opioids can slow down breathing, especially in high doses, leading to life-threatening complications.

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Drowsiness and Cognitive Impairment: These medications can impair judgment, reflexes, and cognitive abilities, increasing the risk of falls or accidents.

Constipation: One of the most common side effects of opioids is severe constipation, which can become chronic and lead to further complications.

Steroids (in Certain Severe Cases):

In some instances of severe cellulitis, corticosteroids like prednisone may be prescribed to reduce inflammation. While effective at reducing swelling, steroids have several potential side effects:

Immune Suppression: Long-term use can suppress the immune system, increasing the risk of infections.

Weight Gain and Fluid Retention: Steroids can cause water retention, weight gain, and swelling in the face or extremities.

Mood Changes: Corticosteroids can cause mood swings, irritability, or even depression or anxiety in some individuals.

Bone Weakening (Osteoporosis): Prolonged use of corticosteroids can weaken bones, increasing the risk of fractures.

Complications of Antibiotic Therapy

Antibiotic Resistance:

The overuse or misuse of antibiotics can lead to the development of antibiotic-resistant bacteria, making future infections more difficult to treat. This is a significant concern, particularly with frequent or long-term use of broad-spectrum antibiotics for recurrent cellulitis.

Allergic Reactions and Anaphylaxis:

Severe allergic reactions to antibiotics can result in anaphylaxis, a life-threatening condition characterized by difficulty breathing, a drop in blood pressure, and swelling of the face or throat. Immediate medical intervention is required if this occurs.

Secondary Infections:

Antibiotics can disrupt the body’s normal bacterial balance, leading to secondary infections like vaginal yeast infections or oral thrush (caused by the overgrowth of Candida), as well as C. difficile colitis, which can cause severe diarrhea and complications requiring further treatment.

While antibiotics and medications used to treat cellulitis are generally effective, they carry a range of potential side effects and complications, from gastrointestinal issues and allergic reactions to kidney and liver damage. In severe cases, the risks increase, particularly with intravenous antibiotics or opioids for pain management. Careful monitoring, dosage management, and communication with healthcare providers are essential to mitigate these risks and ensure the safe and effective treatment of cellulitis.

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The use of both of these drug groups, antibiotics and steroids becomes especially problematic for patients with chronic recurring cellulitis where they are placed on a “merry-go-round” of drugs.

Traditional Medicine, Herbalism, and Manual Therapy, Initial Steps to Treatment

A massage therapist, herbalist, or holistic health practitioner treating cellulitis and performing manual lymphatic drainage (MLD), particularly for clients with complex conditions such as obesity, diabetes, chronic cellulitis, or vascular insufficiency, should take specific steps to ensure both their client’s safety and their own professional liability.

First, it is advisable to obtain a medical referral and prescription from the client’s healthcare provider. This ensures that treatment is appropriate for the client’s condition and is being applied as part of a coordinated care plan, especially in cases involving significant health risks. Additionally, securing informed consent and a release form from the client is crucial. This document should outline the potential benefits and risks of treatment and ensure that the client is fully aware of the treatment plan, thereby reducing the likelihood of misunderstandings or disputes. Furthermore, it is highly recommended that the therapist has an insurance rider on their malpractice policy that specifically covers manual therapy’s such as MLD, as this form of therapy may involve higher risks due to the underlying health conditions of clients who seek it. By taking these steps, the therapist can ensure ethical practice, client safety, and professional protection.

The therapist should complete and maintain accurate records including case history and SOAP notes for every patient appointment and treatment.

A therapist may want to receive additional training or certification specific to the treatment of cellulitis, lymphedema, and cross infection control. American Health Source offers an online cross infection control training program, and their lymphedema workshop offers hands on and lecture training which includes their multistep lymphedema therapy protocol which includes the treatment of cellulitis.

In addition, the therapist should be well acquainted with the contraindications for treatment and care of cellulitis and the early warning signs of an exacerbation. Contraindications include:

MLD or massage therapy should not be performed during the active phase of cellulitis, as it can spread the infection to surrounding tissues or the bloodstream, leading to complications such as sepsis.

If the client presents with fever, chills, or other signs of systemic infection, MLD or massage therapy should be avoided.

Massage or MLD should not be performed over or near areas with open wounds, ulcers, or breaks in the skin, as this can introduce bacteria or worsen the condition.

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MLD and massage therapy are contraindicated if there is a risk or presence of a blood clot, as the therapy could dislodge the clot, leading to life-threatening conditions such as pulmonary embolism.

Massage or MLD is contraindicated in cases of severe venous insufficiency with significant edema, especially if there is the risk of blood clots or ulceration.

MLD should not be performed in clients with active cancer affecting the lymphatic system, as it may promote the spread of cancer cells.

MLD can increase the workload on the cardiovascular system by moving excess fluid, which may be dangerous for clients with heart failure or other severe cardiovascular conditions.

MLD and massage are contraindicated if there are other severe skin conditions present, such as severe eczema, psoriasis, or dermatitis, which may be worsened by manipulation of the skin.

In cases where the skin is extremely fragile or compromised due to diabetes, vascular insufficiency, or previous trauma, massage or MLD should be avoided to prevent further damage.

Warning Signs of Exacerbation (Danger Signs)

Increasing Redness and Swelling - The area of redness (erythema) expands or spreads rapidly, often beyond the initial site of infection. This may indicate the infection is advancing into surrounding tissues.

Worsening Pain - Pain at the site of infection intensifies, or pain begins to spread to areas that were previously unaffected.

Fever or Chills - The onset or worsening of fever, chills, or body aches may indicate that the infection is becoming systemic, affecting the whole body.

Blistering or Pus Formation - The appearance of blisters, pus-filled pockets, or abscesses on or near the affected area can signal a more severe or deeper infection.

Streaking - Red streaks extending from the affected area toward the heart (along lymphatic vessels) are a sign that the infection is spreading through the lymphatic system, a condition known as lymphangitis.

Swollen Lymph Nodes - Swelling and tenderness in the lymph nodes, particularly in the groin, armpit, or neck, may indicate the infection is spreading through the lymphatic system.

Increased Warmth - The affected area feels progressively warmer to the touch, which may signal that inflammation is increasing and the infection is becoming more aggressive.

Rapid Heart Rate (Tachycardia) - An unusually fast heart rate, especially when accompanied by fever or confusion, can indicate that the body is struggling to fight off a more severe infection.

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Confusion or Lethargy - These symptoms, especially in combination with fever, may be signs of sepsis, a life-threatening response to infection spreading throughout the body.

Skin Darkening or Necrosis - The appearance of darkened patches, purple or black spots, or areas of necrosis (dead tissue) on the skin may indicate severe tissue damage or a rapidly advancing infection, possibly requiring surgical intervention.

Difficulty Breathing or Chest Pain - These symptoms may suggest that the infection has entered the bloodstream and is affecting other organs, a medical emergency requiring immediate attention.

If any of these signs appear, the cellulitis is likely worsening or spreading, and immediate medical attention is required to prevent serious complications, such as sepsis, septicemia, abscess formation, or deeper tissue infection.

An Alternative Approach

In addition to conventional medical treatments such as antibiotics used during the acute active stage of infection and inflammation, therapies like manual therapy, manual lymphatic drainage (MLD), herbal medicine, and the use of topical infused oils and salves can offer significant benefits for the treatment and recovery from cellulitis. Manual therapy and MLD focus on improving circulation and lymphatic drainage, which can reduce swelling, promote healing, and prevent recurrence, particularly in individuals prone to chronic infections or lymphatic congestion. Herbal medicine offers a range of antibacterial, anti-inflammatory, and healing herbs that can support the body’s immune response and aid tissue repair. Topical applications, such as herbal-infused oils and salves, can be soothing and antimicrobial, providing relief from pain and inflammation while promoting skin recovery. By incorporating these approaches, cellulitis treatment can become more holistic, addressing both the infection and the underlying conditions that may contribute to its recurrence.

While modern medicine has provided life-saving treatments and advanced our understanding of disease, it is not without significant risks, as shown by the high rates of adverse drug reactions, medical errors, and the removal of drugs from the market due to unforeseen dangers. The reliance on pharmaceutical treatments, despite their known risks, reflects both the strengths and limitations of modern medicine. Herbal medicine and natural therapies, which have a far lower incidence of harm, offer an important complementary approach, particularly for managing non-life-threatening conditions and promoting overall health. The challenge is finding the right balance between utilizing powerful, rapid-acting modern treatments when necessary and integrating safer, longestablished traditional practices for long-term wellness and disease prevention.

In the manual therapy professions, we know that we do not treat active viral, bacterial, or fungal infections (or other infectious causes). Serious infectious disease needs to be treated and managed medically. We can and do, however, treat these conditions in the

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recovery and/or chronic recurrent phase after infection has subsided and we have received medical clearance to treat the patient’s condition.

Cellulitis Treatment During the Acute or Serious Phase

Massage and manual therapy are contraindicated in the acute or severe stages of cellulitis due to the nature of the infection and the risk of exacerbating the condition. Cellulitis is a bacterial infection that affects the deeper layers of the skin and surrounding tissue, leading to symptoms such as redness, swelling, heat, pain, and sometimes systemic symptoms like fever. Applying manual pressure to the affected area through massage or other forms of manual therapy can increase the risk of spreading the infection, as the bacteria could be pushed deeper into the tissues or into the bloodstream. Additionally, the skin is typically inflamed, tender, and weakened during acute cellulitis, meaning that manual manipulation could cause further tissue damage or delay healing. The inflammatory response associated with cellulitis also makes the affected area highly sensitive, and massage could increase pain and inflammation rather than provide relief. For these reasons, it is essential to avoid massage and manual therapy during the active infection phase of cellulitis and wait until the infection has been fully treated and resolved before considering any physical interventions.

However, this does not mean that there are not effective therapies beyond the standard medical drug therapy used during the acute or serious phase of cellulitis. Light therapy, particularly low-level laser therapy (LLLT) and photobiomodulation, is being used as a complementary treatment for cellulitis, especially in its recovery and chronic recurrent phases. These therapies involve applying specific wavelengths of light to the affected area to promote healing, reduce inflammation, and alleviate pain. The mechanisms behind light therapy include stimulating cellular energy production, enhancing circulation, and accelerating tissue repair.

Red light and near-infrared light are commonly used in photobiomodulation because they penetrate deeply into tissues, promoting increased cellular activity and reducing inflammatory processes. These forms of light can help boost collagen production and cell regeneration, which is particularly useful for restoring damaged skin and underlying tissues affected by cellulitis. The application of red or infrared light can also enhance lymphatic drainage, which helps reduce swelling and edema, common issues following cellulitis.

Another promising area of light therapy involves the use of blue light for its antimicrobial properties. Blue light has been shown to kill certain bacteria by disrupting their cellular processes, which could be beneficial in targeting surface-level bacteria or aiding in preventing secondary infections. This use of blue light can be useful in managing skin conditions related to bacterial growth or skin infections that affect the outer layers.

Overall, the benefits of light therapy for cellulitis lie in its ability to support tissue healing, improve blood flow, and reduce inflammation and pain, making it a valuable tool in speeding up recovery and reducing post-infection complications. As research on light-

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based therapies continues to grow, it may become a more widely used approach in managing inflammation and promoting healing in conditions like cellulitis.

Manual Lymphatic Drainage (MLD)

At the Blue Heron Academy and through the continuing education programs of American Health Source we have developed our own manual lymphatic drainage (MLD) techniques and multistep treatment protocols and program. These techniques and protocols are a modern evidence-based approach to the treatment of lymphedema and lymphedema associated cellulitis. We call this program Homeosomatic Lymphedema Therapy (HLT) but to avoid confusion in this booklet we will use the more familiar acronym MLD.

During the non-active phase, manual lymphatic drainage can be a beneficial therapy. MLD helps to reduce swelling, improve circulation, and support the lymphatic system's function, which can be particularly helpful in these conditions. Obesity and diabetes often contribute to poor circulation and lymphedema, which increase the risk of cellulitis. In the non-active phase, MLD can help manage fluid buildup, reduce edema, and promote tissue healing without the risk of spreading infection, as would be the concern during the active phase. Additionally, MLD may help prevent future flare-ups of cellulitis by encouraging better lymphatic flow and reducing stagnation, which is essential in cases where vascular insufficiency is present. However, it’s important to ensure the cellulitis is fully resolved before beginning MLD, and the therapy should be performed by a trained professional, particularly in patients with underlying conditions like diabetes.

Manual lymphatic drainage can be a beneficial therapy for managing chronic cellulitis in the non-active phase when vascular insufficiency is present. In these cases, MLD can help reduce chronic swelling (edema) by encouraging the movement of lymphatic fluid, which can accumulate due to poor circulation and lymphatic drainage. This is particularly important in individuals with vascular insufficiency, as their circulation is compromised, leading to an increased risk of fluid retention and swelling in the lower extremities. By improving lymphatic flow, MLD can help alleviate this swelling, promote better tissue health, and reduce the risk of cellulitis recurrence.

Here are the general steps to the Homeosomatic Lymphedema protocol:

1. Repetitive Movement Technique

2. Lymphedema Technique

3. Extremity Elevation

4. Progressive Capillary Propulsion

5. Muscular Contraction and Relaxation

6. Lymphatic pump, Thoracic

7. Extremity wrapping technique with elevation, single wrap and crosshatch wrap

8. Kinesio Tape Application

9. Compressive Stroking with Elevation

10. Cupping

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11. Bioptron Light Therapy

12. Repetitive Movement Technique (Repeated)

In the Homeosomatic Lymphedema Therapy protocol we also use other ancillary techniques and therapeutic modalities. As previously mentioned, this treatment program is taught at the Blue Heron Academy in its advanced training programs and through American Health Source FastTrack workshops.

Comorbidity and Complicating Conditions

Several comorbid conditions can exacerbate or increase the risk of cellulitis by weakening the immune system, impairing circulation, or causing skin breakdown. These conditions often make individuals more prone to recurrent or severe infections. Here are some of the primary comorbidities that can worsen cellulitis:

Diabetes

Impact: Diabetes can lead to impaired immune function and poor circulation, especially in the lower limbs, which makes it harder for the body to fight infections. Diabetic neuropathy can also result in unnoticed injuries or ulcers, creating an entry point for bacteria.

Result: Individuals with diabetes are at a higher risk of recurrent cellulitis, more severe infections, and complications such as abscesses or tissue necrosis.

Obesity

Impact: Obesity often contributes to poor circulation, especially in the lower extremities, and can lead to lymphedema (swelling due to lymphatic fluid buildup). Skin folds and pressure points can become moist, increasing the risk of skin breakdown and infections.

Result: People with obesity are more likely to experience chronic or recurrent cellulitis, particularly in the legs, as well as complications like lymphedema.

Lymphedema

Impact: Lymphedema is the swelling of tissues due to impaired lymphatic drainage, which can lead to fluid buildup and increase the risk of cellulitis. The excess fluid creates a favorable environment for bacterial growth and reduces the body's ability to fight infections in the affected area.

Result: People with lymphedema are particularly susceptible to recurrent cellulitis, as the fluid buildup makes infections more likely to return or become chronic.

Peripheral Artery Disease (PAD)

Impact: PAD involves narrowing or blockage of arteries, typically in the legs, which restricts blood flow and leads to poor wound healing. The reduced

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circulation increases the risk of skin infections, such as cellulitis, and slows recovery.

Result: Individuals with PAD are at a higher risk of severe or recurrent cellulitis, particularly in the lower extremities.

Chronic Skin Conditions

Impact: Conditions like eczema, psoriasis, and athlete’s foot can lead to chronic skin irritation and breakdown, providing a portal of entry for bacteria that cause cellulitis. These skin conditions can also impair the skin's natural barrier function.

Result: People with chronic skin conditions may experience recurrent cellulitis, especially when the skin is compromised by inflammation or cracking.

Immunosuppressive Conditions

Impact: Conditions that weaken the immune system, such as HIV/AIDS, cancer, or the use of immunosuppressive drugs (e.g., corticosteroids, chemotherapy), reduce the body's ability to fight bacterial infections like cellulitis.

Result: These individuals are more prone to severe, rapidly progressing, or recurrent cellulitis, and may experience complications such as abscesses or systemic infection (sepsis).

Chronic Liver or Kidney Disease

Impact: Liver and kidney diseases can lead to fluid imbalances and edema, particularly in the lower limbs, which increases the risk of cellulitis. These conditions also impair the body’s ability to eliminate toxins and waste, which can further reduce the immune response.

Result: People with liver or kidney disease are at greater risk for cellulitis, particularly if they experience swelling or fluid retention.

Peripheral Neuropathy

Impact: Neuropathy, especially common in diabetes, can lead to a loss of sensation in the feet and legs, making it easier to overlook injuries, cuts, or ulcers that can become infected.

Result: Individuals with peripheral neuropathy are more likely to develop cellulitis because they may not notice or treat minor injuries before they become infected.

Compromised Lymphatic System (Post-Surgery or Radiation)

Impact: Damage to the lymphatic system, such as from surgery or radiation (particularly after cancer treatments), can lead to fluid buildup and increase susceptibility to infections.

Result: Individuals with impaired lymphatic drainage due to surgery or radiation therapy are at higher risk of cellulitis, especially if they have lymphedema.

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Alcoholism

Impact: Alcohol abuse can impair liver function, lead to malnutrition, and suppress immune function, making the body more susceptible to bacterial infections like cellulitis.

Result: Individuals with alcoholism are more prone to developing cellulitis, particularly if they also suffer from liver disease or poor hygiene.

Venous Insufficiency

Impact: Venous insufficiency (poor blood flow in the veins) can lead to fluid accumulation in the legs, which can cause swelling, skin ulcers, and poor wound healing, creating an environment where cellulitis is more likely to develop.

Result: Impaired venous return makes it difficult for the body to heal from cellulitis and increases the likelihood of chronic or recurrent infections in the lower limbs.

Vascular insufficiency complicates cellulitis and comorbid conditions by further impairing circulation, which can slow wound healing and make the skin more prone to infections like cellulitis. MLD can complement the management of vascular insufficiency by enhancing circulation and supporting immune function, which may help prevent the recurrence of infections. However, MLD should only be performed during the non-active phase of cellulitis, as attempting it during an active infection could risk spreading bacteria through the body. Additionally, individuals with diabetes must be closely monitored during MLD treatment to ensure the skin remains intact, as they are at higher risk of skin breakdown and infection due to poor circulation and potential nerve damage from diabetic neuropathy.

For those with obesity and vascular insufficiency, MLD can also help manage conditions like lymphedema, which may exacerbate swelling and contribute to recurring cellulitis. By reducing fluid accumulation and promoting better lymphatic function, MLD supports overall skin health and may prevent further complications. However, care should be taken to avoid excessive pressure, as fragile skin and compromised circulation can increase the risk of injury. Regular MLD sessions, along with appropriate compression therapy and vigilant skin care, can be effective in maintaining good tissue health and preventing future episodes of cellulitis.

Multi-System Dysglycemic Syndrome (MSDS)

The following quote is from my booklet on Multi-System Dysglycemic Syndrome a name I coined to describe a collection of metabolic disorders that are associated with numerous chronic diseases.

“In today’s world, the prevalence of metabolic disorders is on the rise, affecting millions of people globally. Multi-System Dysglycemic Syndrome (MSDS) is a term used to describe a complex interplay of metabolic conditions, including obesity, insulin resistance, metabolic syndrome, diabetes, polycystic ovary syndrome (PCOS), and infertility. These conditions are not isolated but deeply interconnected, often arising from

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common underlying factors such as poor diet, sedentary lifestyle, and genetic predisposition. MSDS represents a significant health challenge, as each component exacerbates the others, creating a vicious cycle that is difficult to break.”

Multi-System Dysglycemic Syndrome plays a significant role in increasing susceptibility to cellulitis. The metabolic imbalances in MSDS lead to chronic inflammation, poor circulation, and compromised immune function, especially in individuals with diabetes and obesity. These factors create an environment where the skin’s protective barriers are weakened, making it easier for bacterial infections like cellulitis to take hold. Obesity and insulin resistance contribute to fluid retention and impaired lymphatic drainage, which can exacerbate swelling and tissue breakdown, particularly in the lower extremities. Additionally, individuals with MSDS often experience delayed wound healing and are prone to recurrent infections, making them more vulnerable to severe and recurrent cellulitis. The interconnected nature of the metabolic conditions within MSDS compounds these risks, making cellulitis not just a complication but a frequent and challenging issue for those affected.

Herbal Medicine and Herbal Infused Oil Treatments for Cellulitis

Herbal remedies with antibacterial, anti-inflammatory, and immune-boosting properties have been used traditionally to support healing and prevent infections related to cellulitis and similar conditions. I do not recommend using herbal medicines topically during the active stage of cellulitis, not because they are not effective, but because of the legal risks involved should an infection get worse or spread into deeper layers of tissue. Alternative and holistic health practitioners do not have the same level of protection as medical physicians or workers in the allied medical professions. It is best to let the medical professionals use antibiotics in the active, acute and serious stages of cellulitis and to get a medical referral for MLD once the infection has been brought under control and the patient is in the recovery stage. Even when the patient is in the recovery stage extreme care must be exercised to assure that the manual and holistic support and treatment that is provided does not exacerbate the patient's condition.

In the herbal literature there are numerous herbs that have been found to be of benefit in the treatment of cellulitis. Avoid any treatment or application to any area of broken skin or open wounds. These conditions need immediate medical attention. Some of these herbs include:

Garlic (Allium sativum) Active Compounds: Allicin

Properties: Garlic has strong antibacterial, antiviral, and antifungal properties. Allicin, the active compound in garlic, can inhibit the growth of many harmful bacteria, including Staphylococcus and Streptococcus species, which are common causes of cellulitis.

Usage: Garlic can be consumed fresh or used topically in diluted form, though caution should be taken to avoid irritating broken skin.

Dr. Gregory T. Lawton

Goldenseal (Hydrastis canadensis) Active Compounds: Berberine

Properties: Goldenseal is a traditional herbal remedy with antibacterial and antiinflammatory properties. Berberine, the main active compound, has been shown to be effective against a variety of bacteria.

Usage: Goldenseal can be taken internally as a tincture, capsule, or tea. It may help support the body’s ability to fight infections.

Turmeric (Curcuma longa) Active Compounds: Curcumin

Properties: Turmeric has powerful anti-inflammatory and antibacterial properties. Curcumin can help reduce inflammation and support the immune response in fighting infections.

Usage: Turmeric can be used internally in food or supplements. Topically, a paste of turmeric and water can be applied to unbroken skin, but care should be taken with open wounds.

Thyme (Thymus vulgaris) Active Compounds: Thymol, carvacrol

Properties: Thyme oil contains thymol, which has strong antibacterial and antifungal properties. It can be effective in inhibiting bacteria like Staphylococcus aureus.

Usage: Thyme can be used as a tea or as an essential oil diluted for topical application (not on open wounds).

Oregano (Origanum vulgare) Active Compounds: Carvacrol, thymol

Properties: Oregano oil is a potent natural antibiotic with broad-spectrum antimicrobial effects. It has been shown to inhibit the growth of various bacteria, including those that cause skin infections.

Usage: Oregano oil should be diluted in a carrier oil before applying to the skin (avoiding open wounds).

Calendula (Calendula officinalis) Active Compounds: Flavonoids, triterpenoids

Properties: Calendula is used for its antimicrobial and anti-inflammatory effects. It promotes wound healing and helps prevent infection in minor wounds.

Usage: Calendula can be applied topically as a salve or ointment to unbroken skin or minor wounds, helping support the healing process.

Tea Tree Oil (Melaleuca alternifolia) Active Compounds: Terpinen-4-ol

Properties: Tea tree oil is well-known for its antibacterial, antifungal, and antiviral properties. It can be used topically to help fight infections.

Usage: Tea tree oil must be diluted in a carrier oil before being applied to the skin. It is effective against bacteria like Staphylococcus and Streptococcus but avoid use on broken skin or open wounds.

Dr. Gregory T. Lawton

However, in my clinical practice of medical herbalism and if I could only use four herbs in the treatment of infectious cellulitis and cellulitis used internally and topically it would be these three herbs:

When using herbal remedies like castor oil, violet-infused oil, calendula-infused oil, and sage for the treatment of cellulitis, it's important to keep in mind the stage of the infection and how these oils might interact with the affected skin. While these herbal infused oils have potential healing and anti-inflammatory properties, they should not replace conventional antibiotic treatment during the active phase of cellulitis

Castor oil is used externally as a castor oil pack, and not internally. Violet, calendula, and sage are used both internally and externally

Castor Oil (Ricinus communis):

Castor oil is known for its anti-inflammatory, antimicrobial, and pain-relieving properties. It is also a strong humectant, drawing moisture into the skin, which can support healing in certain conditions. During the post-infection phase, castor oil can be applied to help soothe the skin, reduce inflammation, and support tissue repair. It may help improve circulation in the area and aid the healing process. However, it should not be applied to broken or highly inflamed skin during the active infection phase. If the area or region to be treated is hot and inflamed use a “cold” room temperature castor oil pack and do not heat it or add water to the pack.

Active Chemical Constituents: Ricinoleic acid, oleic acid, linoleic acid, and flavonoids.

Violet - Infused Oil (Viola odorata):

Violet is traditionally used in herbal medicine for its cooling, anti-inflammatory, and soothing properties. It has been used to treat inflamed and irritated skin conditions. Violet-infused oil may be beneficial for soothing skin irritation and reducing inflammation once cellulitis has entered the non-active or recovery phase. Its cooling effect could provide relief for areas of residual swelling and irritation after the infection has resolved. Again, it should not be used during the active phase, especially on broken skin.

Active Chemical Constituents: Methyl salicylate, rutin, saponins, and alkaloids.

Calendula - Infused Oil (Calendula officinalis):

Calendula is well-known for its wound-healing, anti-inflammatory, and antimicrobial properties. It helps promote skin regeneration and reduce inflammation. Calendulainfused oil can be particularly helpful in post-cellulitis recovery. It may help promote skin healing, reduce scarring, and support overall skin repair. It’s ideal for use on skin that is no longer infected but still in need of regeneration. Calendula’s mild antimicrobial properties may also help protect the skin from secondary infections during recovery.

Dr. Gregory T. Lawton

During the active phase of cellulitis, conventional antibiotics should be the primary treatment, and applying oils to the infected area is generally not recommended as it could trap moisture and worsen the infection.

Active Chemical Constituents: Methyl salicylate, rutin, saponins, and alkaloids.

Sage-Infused Oil (Salvia officinalis)

Sage contains several potent compounds, including thujone and camphor, which have antimicrobial and anti-inflammatory properties. Rosmarinic acid and ursolic acid also contribute to its antioxidant and wound-healing effects. Sage is often used to help reduce inflammation and prevent bacterial growth. Sage infused oil can be beneficial during the recovery phase of cellulitis, particularly in soothing residual inflammation and preventing further bacterial infections. Its antimicrobial and anti-inflammatory properties, primarily due to thujone and rosmarinic acid, make it helpful in maintaining skin health during healing.

Sage is especially helpful when vascular insufficiency has complicated the patients condition.

Active Chemical Constituents: Thujone, camphor, rosmarinic acid, ursolic acid, and flavonoids.

Herbal Infused Oil Therapy

Once cellulitis (the active infectious stage) has resolved and the patient is in the recovery stage and the skin is no longer inflamed or broken, these oils may be used to support healing:

1. Castor oil topically for its anti-inflammatory and circulation-promoting effects.

2. Violet-infused oil for its cooling, soothing properties on irritated skin.

3. Calendula-infused oil for its skin-healing, antimicrobial, and inflammationreducing benefits.

4. Sage-infused oil (Salvia officinalis) for its antimicrobial and anti-inflammatory properties, thanks to thujone, camphor, and rosmarinic acid. Sage may be used internally for its effects on circulation and blood vessels.

Conclusion

Herbal medicines such as castor oil (Ricinus communis), violet-infused oil (Viola odorata), calendula-infused oil (Calendula officinalis), and sage-infused oil (Salvia officinalis) offer significant therapeutic benefits due to their anti-inflammatory, antimicrobial, and healing properties During the active phase of cellulitis, the infection requires immediate medical attention and treatment with conventional antibiotics, as applying oils directly to inflamed or broken skin may trap moisture and worsen the infection. Once cellulitis has resolved and is in the non-active phase, these herbal oils can provide valuable support for post-infection recovery. Castor oil, rich in ricinoleic acid, can help reduce inflammation and support circulation, while violet-infused oil offers

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cooling, soothing effects due to its methyl salicylate content. Calendula-infused oil, with its triterpenoids and flavonoids, promotes skin healing and reduces inflammation, and sage-infused oil, with its antimicrobial compounds like thujone and rosmarinic acid, helps prevent bacterial growth and soothe residual irritation.

Both violet and calendula may be consumed as infusions, as a tincture, or as a powder in capsules.

Additionally, manual lymphatic drainage (MLD) should not be performed during the active phase of cellulitis, as it risks spreading the infection to other areas or into the bloodstream. However, once cellulitis has entered the non-active phase, MLD can be beneficial, especially in individuals with conditions like obesity, diabetes, chronic cellulitis, lymphedema, or vascular insufficiency. MLD helps improve lymphatic circulation, reduce swelling, and prevent fluid buildup, which is particularly useful in managing chronic or recurrent cellulitis. It is important to ensure that the infection is fully resolved before starting MLD MLD with the use of herbal-infused oils during the recovery phase can support overall healing and help prevent future infections.

Treating the underlying causes of cellulitis requires addressing the broader health conditions that increase susceptibility to infection, particularly those associated with metabolic syndrome, insulin resistance, diabetes, obesity, and other chronic diseases. Conditions like heart disease, high blood pressure, lung disease, kidney disease, and liver disease all compromise the body’s ability to fight infections, impair circulation, and contribute to inflammation. Managing these underlying conditions is key to reducing the risk and recurrence of cellulitis. For individuals with metabolic syndrome and insulin resistance, focusing on improving blood sugar control through dietary changes, physical activity, and weight management can strengthen the immune system and enhance circulation. Obesity exacerbates poor lymphatic drainage and fluid retention, leading to swelling that can create an environment for bacterial infections. Weight loss, along with addressing high blood pressure and heart disease through lifestyle modifications and appropriate medical treatments, can reduce strain on the cardiovascular system, improving blood flow to the skin and extremities. Lung disease and kidney disease often contribute to poor oxygenation and fluid retention, both of which increase the likelihood of cellulitis, so managing these conditions with medication and lifestyle changes is crucial. Liver disease, which can impair detoxification and lead to fluid buildup, also increases the risk of cellulitis, making it essential to address liver health through proper diet, alcohol management, and health care. By treating these underlying conditions, improving immune function, and enhancing circulatory health, individuals can significantly reduce their risk of developing cellulitis and improve overall health outcomes.

Dr. Gregory T. Lawton