Lower limb cellulitis

• Cellulitis is a common bacterial skin infection involving the deeper layers of the skin and subcutaneous tissues.
• Lower limbs are frequently affected.

Common in all age groups, but higher incidence in elderly and immunocompromised individuals.

• Typically caused by Streptococcus and Staphylococcus species, including MRSA.
• The bacteria enter through breaks in the skin (cuts, abrasions, ulcers, athlete’s foot).

• Skin breaches.
• Lymphoedema.
• Obesity.
• Diabetes.
• Chronic venous insufficiency.

• Acute onset of erythema, swelling, warmth, and tenderness of the affected area.
• Systemic symptoms may include fever, chills, and malaise.
• Skin may appear tight, glossy, and blistered in severe cases.
• Lymphangitis and regional lymphadenopathy may be present.

• Primarily clinical, based on history and examination.
• Laboratory tests (CBC, CRP, ESR) may show raised inflammatory markers.
• Blood cultures and swabs from any open wounds to identify causative organisms, particularly in severe or recurrent cases.

• Mild to Moderate Cases:

  • Oral antibiotics (e.g., flucloxacillin, or erythromycin/clindamycin for penicillin-allergic patients).
  • Elevating the affected limb and analgesia for symptom relief.

• Severe Cases:

  • Intravenous antibiotics (e.g., IV flucloxacillin, or vancomycin in cases of suspected MRSA).
  • Consider hospital admission for systemic symptoms or rapid progression.

• Recurrent Cellulitis:

  • May require prophylactic antibiotics.
  • Address underlying risk factors (e.g., skin care, compression therapy for oedema).

• Abscess formation, necrotising fasciitis, sepsis.
• Chronic lymphoedema due to damage of lymphatic vessels.
• Recurrent episodes, particularly in individuals with chronic risk factors.

• Generally good with appropriate antibiotic treatment.
• Chronic or recurrent cellulitis may develop in patients with predisposing factors.

• Lower limb cellulitis is a common Streptococcus/Staphylococcus bacterial skin infection caused by skin breaches.
• Onset is acute, with erythema, swelling, warmth, and tenderness of the limb.
• Diagnosis is from clinical suspicion, with laboratory tests, blood culture and swabs aiding diagnosis.
• Management is dependent on severity and includes antibiotics (IV or oral), symptomatic relief and management of underlying risk factors.