Cellultitis/red Legs As Complexities In The Management Of Lower Limb Wounds

BLOG: Rebecca Elwell, Lymphoedema Clinical Lead looks into how cellulitis and red leg can lead to complexities in venous leg ulcer management.

The British Lymphology Society(BLS) is a dynamic and innovative body providing a strong professional voice and support for those involved in the care and treatment of people with lymphoedema and related lymphatic disorders, including lipoedema. As a current trustee I am dedicated to achieving the BLS goal of establishing high standards of care and equitable access to treatment across the UK and promoting early detection and intervention and, where appropriate, screening and prevention. 

The Best Practice Statement addressing complexities in the management of venous leg ulcers (Wounds UK, 2019) recognises the importance of assessing wound and surrounding skin so that an appropriate management plan can be started as soon as possible. Lymphoedema/chronic oedema results in common skin changes which can lead to complexities in venous leg ulcer management, as a reviewer for the document I was keen to promote the management of cellulitis and red legs. 

Cellulitis is an acute spreading inflammation of the skin and subcutaneous tissues characterised by pain, warmth, swelling and erythema. Cellulitis can be difficult to diagnose and to distinguish from other causes of inflammation particularly in the legs (BLS) e.g.  Varicose eczema. Cellulitis most commonly affects one leg only whereas RED LEGS more commonly affects both legs. 

In bilateral red legs differential diagnosis should always take place and management of any chronic skin changes should be promptly administered. 

Treatment is usually in the form of washing daily with a soap substitute, drying thoroughly especially in between the toes and in any deepened skin folds and then moisturise with a bland emollient. After waiting 30 minutes a potent steroid cream should be applied sparingly to the affected areas for a maximum of 2 weeks and if still required a reduced strength steroid cream should be employed e.g. Betnovate RD. Protective skin layer garments should then be applied e.g. Skinnies or Dermasilk heelless socks underneath compression hosiery.

Compression therapy works by aiding venous return by increasing the blood flow in the veins and it reduces oedema by facilitating lymphatic uptake and stopping the accumulation of lymph fluid in the limbs. Correctly applied and selected levels of compression can reduce exudate, reverse skin changes and aid the healing of venous ulceration. Following healing compression hosiery can prevent recurrence of red legs, skin changes and ulceration.

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