Risk Factors for Erysipelas of the Leg in Tunisia: A Multicenter Case-Control Study

Abstract

Background: Risk factors for erysipelas (cellulitis) were rarely evaluated in controlled studies. Regional variations of these risk factors have never be assessed. Objective: To assess risk factors for erysipelas of the leg in Tunisia. Subjects and Methods: Case-control study in seven hospital centers in Tunisia. Cases were 114 consecutive patients with erysipelas of the leg [sudden onset (<24 h) of a well-demarcated dermo-hypodermatitis with fever or chills]. Two controls were matched to each case for age, sex, and hospital (n = 208). Main outcome measures are local and general suspected risk factors for erysipelas of the leg. Results: In multivariate analysis, disruption of the cutaneous barrier (i.e. traumatic wound, toe-web intertrigo, excoriated leg dermatosis or plantar squamous lesions) and leg edema were independently associated with erysipelas of the leg, with respective odds ratios of 13.6 (95% confidence interval: 6.0–31) and 7.0 (1.3–38). No association was observed with diabetes, alcoholism, or smoking. Conclusions: We confirmed the major role of local risk factors and the minor role of general risk factors for erysipelas of the leg, in a setting different than the one previously studied. Detecting and treating toe-web intertrigo and traumatic wounds should be considered in the prevention of erysipelas of the leg.

Risk factors of acute cellulitis in adult patients: A case-control study

“…Previous trauma and regional surgery were significantly associated with cellulitis in our study. In accordance with our findings some previous studies reported that traumatic wound and previous surgery were risk factors for cellulitis (7,8,(14)(15)(16). Defects in cutaneous barrier caused by trauma and surgery facilitate the entry of pathogens to skin and development of infection.…”

“…Dupuy et al (6) in their study reported that being overweight was a risk factor associated with cellulitis of the leg. Similarly, obesity and higher BMI was independent risk factors for acute cellulitis in some other studies (8,14,17). In a prospective case-control study of 100 subjects with cellulitis and 200 control subjects, matched for age and sex, obesity was significantly more frequent in the case patient group, but being overweight was not (5).…”

“…In contrast, we found that diabetes is an independent systemic risk factor for cellulitis. Similarly, Mokni et al (8) in their study reported that diabetes was associated with increased risk of cellulitis. Two studies conducted among hospitalized adults to evaluate the factors that contribute to the development of cellulitis.…”

“…This phenomenon leads to an imbalance between biosynthesis and degradation of dermal proteins (30). In contrast some other studies did not show any association between smoking and risk of cellulitis (5)(6)(7)(8). Most studies about cellulitis did not evaluate the role of corticosteroid use.…”

“…Some other potential risk factors reported in studies including diabetes mellitus, prior malignancy, body mass index (BMI), smoking, alcoholism and ethnicity with controversial findings. Most of these previous studies reported that general risk factors have little role in the development of cellulitis (5)(6)(7)(8). The better identification of preventable risk factors for cellulitis has significant implications for reducing morbidity and mortality from this diseases and improving patient management.…”