PART 1 OF 5: Dermatologic pathologies are featured in a 5-part series grouped by causative factors such as bacteria, fungi, viruses, skin injuries, and inflammation. This article focuses on massage modifications for bacterial skin infections including MRSA, acne, folliculitis, impetigo, boils, and cellulitis. Read on!

This article focuses on massage modifications for bacterial skin infections including MRSA, acne, folliculitis, impetigo, boils, and cellulitis.

MRSA stands for methicillin-resistant Staphylococcus aureus, and it is a strain of bacteria that has become resistant to antibiotics. The five C’s of spreading MRSA are (1) crowding, (2) contact, (3) compromised skin, (4) contaminated items, and (5) cleanliness. MRSA infections occur more often in people who live or work in crowded conditions such as hospitals, health care facilities, and athletic or educational institutions. Many infections are spread by direct contact with infected skin. Infections occur more often on skin that contained cuts, scrapes, or small abrasions. MRSA can spread by indirect contact with infected items such as towels, clothes or floor mats. Lack of cleanliness is associated with increased risk of MRSA. Massage considerations for MRSA are included in the entry on “Boils.”

Screen Shot 2017-04-26 at 4.02.39 PM

Acne: Acne is an inflammatory bacterial infection of the hair follicles and their associated sebaceous glands. Acne is most commonly found on the face, but it also can appear on the V of the chest and upper back, neck, and shoulders; this is where the greatest number of sebaceous glands are located.


Massage Therapy and Acne: The American Academy of Dermatology (AAD) recommends avoiding affected areas because pressure and friction from physical contact may cause acne to worsen (1). Because heat may also aggravate acne, avoid the use of table warmers or hot packs over affected areas.

Folliculitis: Folliculitis is inflammation of hair follicles; it can occur anywhere in hair-bearing skin but is seen mainly in the groin, the axilla, or the bearded areas of men (barber’s itch or folliculitis barbae). Hot tub folliculitis can occur after use of improperly cleaned hot tubs; affected areas in these cases are the legs, hips, and buttocks. Severe or widespread folliculitis may further develop into a boil.


Massage Therapy and Folliculitis: Avoid affected areas because massage may further irritate hair follicles, cause pain, and may lead to secondary infections.


Impetigo: Impetigo is a bacterial infection that occurs mainly around the mouth, nose, and skin folds such as the axillae. Impetigo is more common in children than in adults. This skin condition is highly contagious and can spread by direct contact with an infected person or by handling contaminated objects. The most common causes of impetigo are staphylococci or streptococci bacteria.


Massage Therapy and Impetigo: Avoid the affected area during the massage because the bacterium that causes impetigo is contagious. Some therapists elect to avoid direct contact with the client’s hands in case the client has touched the affected area. As an alternative, you can massage the client’s hands through a barrier such as disposable gloves or the sheet drape. Linens, such as face rest covers, that come into contact with lesions are treated as contaminated.

Boils: Boils are deeply infected hair follicles that spread to surrounding areas. Boils are also called furuncles. Boils can occur anywhere on the body, but they are most common on the face, neck, back, buttocks, and thighs. The most common cause of boils are staphylococcal bacteria, but boils may be caused by fungi or other bacteria such as methicillin-resistant Staphylococcus aureus (MRSA). If a boil does not heal within 2 weeks with or without treatment, it should be reevaluated for MRSA infection.


Massage Therapy, Boils, and MRSA: Avoid the affected area during the massage because the bacteria that cause boils are contagious. Linens, such as face rest covers, that come into contact with lesions are treated as contaminated. Be sure you wash and dry your hands before and after massage, or when leaving a high-risk institution such as a hospital.

Cellulitis: Cellulitis is a bacterial infection of the skin and underlying tissues. Cellulitis often arises from a skin wound or a boil. Left untreated, cellulitis can spread to the bloodstream (bacteremia) and become a systemic and sometimes life-threatening condition. The most common causes of cellulitis are Streptococcus and Staphylococcus bacteria. Cellulitis is characterized by localized swelling, redness, warmth, and painful tender skin.


Massage Therapy and Cellulitis: If you notice signs and symptoms of cellulitis in the affected limb (e.g., localized swelling, redness, warmth, painful tender skin), postpone the massage and urge your client to seek immediate medical attention. If left untreated, cellulitis may spread rapidly and become life threatening.  It is important to note that clients diagnosed with cancer often undergo cancer treatments such as surgery, radiation, and chemotherapy. These treatments often reduce the number of lymph nodes in an area. This reduction may lead to lymphedema. Cellulitis may occur as a complication of lymphedema.


Picture Credits:

Salvo Susan “Mosby’s Pathology for Massage Therapists, 4e.

Articles and Journals Referenced:

  1. American Academy of Dermatology. Retrieved from


Susan Salvo is a board certified massage therapist with 30+ years of experience. Susan is passionate about massage therapy and massage education. You can contact her at