Research Advances
Compression counters cellulitis How compression therapy substantially reduces the recurrence of cellulitis By Elizabeth Webb
This following is a brief synopsis of the results of the randomised controlled trial ‘Compression Therapy to Prevent Recurrent Cellulitis of the Leg’. The full report can be accessed through the New England Journal of Medicine. www.nejm.org/doi/full/10.1056/NEJMoa1917197 What is cellulitis? Cellulitis is a common bacterial infection of the skin and tissue beneath the skin. It presents as a red spreading rash that can be hot, painful, and/or swollen. It can occur anywhere on the body but most often occurs in legs. For some people it can make them very sick, requiring hospital admission. Although many people have never heard of cellulitis, in the United States it leads to over 650,000 hospital admissions per year and it is estimated there are 14.5 million cases annually.1 Those with chronic edema (edema lasting three or more months) are at greater risk of developing cellulitis. A recent study by Burian et al. showed that in patients with chronic edema, 16% were diagnosed with cellulitis within the last year, and 37% had suffered an episode during their lifetime.2 Cellulitis reoccurs One of the challenges with cellulitis is that it is likely to reoccur. Up to 47% of those who have experienced an episode of cellulitis will have a repeat infection within three years3 with some people suffering multiple infections. This can cause significant personal challenges, impeding people’s ability to work and function. Similarly, it can contribute to substantial social challenges, causing extended periods of sick leave and often contributing significant
costs to the healthcare system, including the risks and demands of antibiotics in a climate of increasing antibiotic resistance. Cellulitis/edema – a vicious cycle Unfortunately people with chronic edema/ lymphedema are already at an increased risk of developing cellulitis. Sadly, when an episode of cellulitis does occur, it damages the lymphatic vessels further, leading to worsening swelling and even greater risk of repeated cellulitis infections, making it a vicious cycle.
Elizabeth Webb, PT is a physiotherapist working in the lymphedema service at Calvary Public Hospital Bruce in Canberra, Australia. She is currently completing a PhD through the University of Canberra investigating the impact and cost of compression therapy on recurrent cellulitis.
Spring 2021
Preventing cellulitis Previously the only known effective treatment to prevent cellulitis was antibiotics. Prophylactic antibiotics are effective in preventing cellulitis, but only when they are being taken, with the effect diminishing once stopped. For many years, clinicians and experts in the field of lymphedema have believed that managing chronic edema with compression would decrease the risk of cellulitis infections, but until recently, there has not been sufficient evidence to support this theory. New research The Calvary Public Hospital Bruce lymphedema service in Australia, started a randomized controlled trial to explore whether managing chronic edema with compression therapy would Ly m p h e d e m a p a t h w a y s . c a 5