Red legs: how to differentiate between cellulitis, venous eczema and lipodermatosclerosis
Nurses often encounter people with red legs. There are a number of reasons why an individual may develop red legs. The most common causes of red legs are cellulitis, venous eczema and lipodermatosclerosis. All have different causes and require different treatments. This article aims to enable readers to differentiate between these conditions which can appear similar, and to offer effective evidence-based care.
Cellulitis is an ambulatory care sensitive condition (ACSC). Its effective management and treatment should prevent admission to hospital; cellulitis is usually diagnosed in primary care and treated at home (NHS England, 2017). Each year, 100 000 people in England are admitted to hospital with cellulitis of the lower leg (Santer et al, 2018).
Misdiagnosis of lower leg cellulitis is common. Around 33% of people diagnosed with cellulitis usually have other conditions and around 90% of people who are misdiagnosed are inappropriately treated with antibiotics (Levell, 2011; Weng et al, 2017; Patel et al, 2019a; O'Brien and White, 2021).
It is vital to accurately diagnose this condition, as an incorrect diagnosis can expose the person to hazards of antibiotic therapy, increase antibiotic resistance and cause delays in providing appropriate effective treatment (Hirschmann and Raugi, 2012a; 2012b). Fig 1 illustrates the consequences of incorrect diagnosis.
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