Compression therapy may lower recurrent cellulitis in patients with chronic leg edema

1. Compression therapy significantly reduced the incidence of cellulitis recurrence for participants with leg edema and cellulitis compared to conservative management.

2. Compression therapy reduced edematous leg volume more effectively compared to education management.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Cellulitis is a bacterial infection of the skin and subcutaneous tissue with a high recurrence rate. One risk factor for recurrent cellulitis is chronic edema, where swelling persists for more than three months. Current prophylactic treatment for recurrent cellulitis is penicillin. However, nonantibiotic treatments have not been studied. As such, this study determined the efficacy of compression therapy to prevent cellulitis recurrence in participants with chronic leg edema, since the therapy has been shown to effectively control chronic leg edema. The results demonstrated that compression therapy significantly lowered cellulitis recurrence incidence for participants with chronic leg edema. This randomized trial was limited by its non-blinded study design. Nonetheless, this study was strengthened because it was the first to analyze a nonantibiotic treatment for cellulitis.

Click to read the study in NEJM

Relevant Reading: Effect of Dermatology Consultation on Outcomes for Patients with Presumed Cellulitis: A Randomized Clinical Trial

In-Depth [randomized controlled trial]: This randomized control trial enrolled 84 participants in a single-center study in Australia. Participants included in the study had a history of at least two episodes of cellulitis in the same leg and had chronic edema in either one or both legs. Participants younger than 18 years of age, who had received end-of-life care, had worn effective compression garments for more than five days per week, or had a chronic wound were excluded from this study. The patients were randomized in a 1:1 ratio to receive compression therapy plus cellulitis prevention education or cellulitis prevention education only. The primary outcome was cellulitis recurrence and follow-up ranged from 0 to 511 days with a median of 186 days. Specifically, the median follow-up time for the compression group was 209 days compared to the control group of 77 days. During the follow-up interviews, 88% of participants in the compression group had worn the garments at least four days per week, while 73% of the participants reported wearing the garments at least five days per week. Cellulitis recurrence occurred in 6 of 41 participants (15%) in the compression group compared to 17 of 43 participants (40%) in the control group (hazard ratio, 0.23; 95% confidence interval [CI] 0.09 to 0.59; P=0.002). In addition, hospital admission occurred for 3 participants (7%) in the compression group compared to 6 participants (14%) in the control group (hazard ratio, 0.38; 95% CI, 0.09 to 1.59). Furthermore, the mean leg volume for participants in the compression group was 181 mL less than at baseline compared to the mean leg volume for participants in the control group which increased by 60 mL (between-group difference in change, -241 mL; 95% CI, -365 to -117). Taken together, compression therapy along with cellulitis prevention education significantly lowered cellulitis recurrence incidence and reduced the leg volume compared to conservative management.

Image: PD

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