Usually unilateral, demarcated erythema, swelling, tenderness and warmthTx.: long term tx. of cellulitis has not been well studied, but in a small group of patients with recurrent cellulitis, the tx. group (Erythromycin 250 mg bid) didn’t develop cellulitis compared to 8 in the non-tx. group.
- There are no published studies to identify who is a candidate for long term tx. and for how long but uptodate suggest the following if considering long-term tx. for cellulitis
-ABX should be at least for 12 months, (Acute tx. should be for 12-14 days)-Macrolides aren’t recommended d/t increased resistance, instead use Dicloxacillin 500 mg po bid. will cover both beta-hemolytic streptococci and S. Aureas-If MRSA is suspected, use Clindamycin 150 mg po q day (think of C. diff education)- Tx. Tinea pedis: Naftifine gel and terbinafine cream are allylamine-class products that are appropriate treatment options for topical therapy
Stasis dermatitis is the most common cause of pseudocellulitis
Chronic venous insufficiency: occurs when the venous pressure is increased and the return of blood is impaired (mm. pump dysfunction),
Unabated venous hypertension may result in dermal changes with hyperpigmentation, subcutaneous tissue fibrosis (“lipodermatosclerosis”), and eventual ulceration. (Chronic venous insufficiency)
capillary leak, fibrin deposition, erythrocyte and leukocyte sequestration, thrombocytosis, and inflammation. These processes impair oxygenation of the skin and subcutaneous tissues. The clinical manifestations of severe venous hypertension and tissue hypoxia are edema, hyperpigmentation, subcutaneous fibrosis, and ulcer formation
Chronic venous insufficiency
BLE swelling and redness is rare for dx. of cellulitis and more indicative of stasis dermatitis
Lymphedema and leg ulcerations can be underlying cause of symptoms and acute or repeated cellulitis
Management of stasis dermatitis● General measures to reduce edema and venous hypertension (eg, leg
elevation, daily walking, exercise, weight reduction)● Continuous compression therapy● Systemic therapy, including venoactive or phlebotonic drugs (eg,
hydroxyethylrutoside, escin [horse chestnut extract], calcium dobesilate), flavonoids (eg, diosmin and hesperidin, diosmiplex), or pentoxifyllin
Tx: We suggest topical corticosteroids for patients with stasis dermatitis who have erythema, pruritus, vesiculation, and oozing. High- or mid-potency corticosteroids
ie. Triamcinolone 0.1% cream, apply once or twice daily for 1-2 weeks
Tx: closed dressings that are also compression, unna boots (1x/wk. change)4-layer compression wrapOTC hosiery (last 6 months if wearing everyday)TED hose (last 6 months if wearing everyday)
Compression therapy is contraindicated in patients with peripheral artery disease, cellulitis, and acute deep vein thrombosis. Noninvasive arterial studies should be performed on patients with lower extremity ulcer who have weak or nonpalpable pulses or risk factors for atherosclerosis. Cellulitis and deep vein thrombosis should be treated prior to placement of compression bandages
Patients with persistent symptoms (pain, aching, swelling) and signs (telangiectasias, reticular veins, varicose veins, skin changes, ulceration) of venous disease after a period of conservative management, typically three months, and documented reflux (ie, retrograde flow >0.5 second duration) as a source of their symptoms are candidates for vein ablation therapy
If a clinical diagnosis of venous insufficiency or obstruction cannot be established but symptoms are strongly suggestive.
In patients with signs of chronic venous disease but whose symptoms are questionably related to the venous disease.
In atypical cases, such as an unusually early age of onset (<40 years) of symptoms, or following trauma.
In cases of ulceration. Patients with ulceration due to superficial venous reflux may benefit from venous ablation
procedures. Significantly decreased ulcer recurrence rates have been found with removal or ablation of greater or small
saphenous veins .
In patients with clinically suspected venous disease who do not respond to standard conservative measures