British Lymphology Society 2016 - Consensus Document on the Management of Cellulitis in Lymphoedema

21 Oct 2018

Cellulitis is an acute spreading inflammation of the skin and subcutaneous tissues characterised by pain, warmth, swelling and erythema. Cellulitis is sometimes called erysipelas or lymphangitis. In lymphoedema, attacks are variable in presentation and may differ from classical cellulitis. Most episodes are believed to be caused by Group A Streptococci (Mortimer 2000, Cox 2009). However, microbiologists consider Staph aureus to be the cause in some patients (e.g. Chira and Miller, 2010).

Some episodes are accompanied by severe systemic upset, with high fever and rigors; others are milder, with minimal or no fever. Increased swelling of the affected area may occur. Inflammatory markers (CRP, ESR) may be raised. It is difficult to predict response to treatment. Cellulitis can be difficult to diagnose and to distinguish from other causes of inflammation particularly in the legs e.g. lipodermatosclerosis. Cellulitis most commonly affects one leg only whereas lipodermatosclerosis more commonly affects both legs.

A Cochrane review concluded that it was not possible to define the best treatment for cellulitis in general based upon existing evidence (Kilburn et al 2010). Furthermore, the treatment of cellulitis in lymphoedema may differ from conventional cellulitis.

With this background, this consensus document makes recommendations about the use of antibiotics for cellulitis in patients with lymphoedema, and advises when admission to hospital is indicated. Prompt treatment is essential to avoid further damage to the lymphatics of the affected part which in turn may predispose to repeated attacks.