Risk factors for erysipelas of the leg (cellulitis): case-control study

Abstract

Objective To assess risk factors for erysipelas of the leg (cellulitis). Design Case-control study. Setting 7 hospital centres in France. Subjects 167 patients admitted to hospital for erysipelas of the leg and 294 controls. Results In multivariate analysis, a disruption of the cutaneous barrier (leg ulcer, wound, fissurated toe-web intertrigo, pressure ulcer, or leg dermatosis) (odds ratio 23.8, 95% confidence interval 10.7 to 52.5), lymphoedema (71.2, 5.6 to 908), venous insufficiency (2.9, 1.0 to 8.7), leg oedema (2.5, 1.2 to 5.1) and being overweight (2.0, 1.1 to 3.7) were independently associated with erysipelas of the leg. No association was observed with diabetes, alcohol, or smoking. Population attributable risk for toe-web intertrigo was 61%. Conclusion This first case-control study highlights the major role of local risk factors (mainly lymphoedema and site of entry) in erysipelas of the leg. From a public health perspective, detecting and treating toe-web intertrigo should be evaluated in the secondary prevention of erysipelas of the leg.

Predictors of Failure of Empiric Outpatient Antibiotic Therapy in Emergency Department Patients With Uncomplicated Cellulitis

“…[14][15][16][17] These studies showed that disruption of the cutaneous barrier (leg ulcer, wound, fissurated toe-web intertrigo, pressure ulcer, or leg dermatosis), venous insufficiency, leg edema, being overweight, fungal infections, history of cellulitis, chronic venous insufficiency, prior saphenectomy, white race, and the presence of Staphylococcus aureus and/or B-hemolytic streptococci in the toe webs to be independently associated with cellulitis.…”

Celulitis y erisipela: Manejo en atención primaria

“…Estudios recientes han permitido precisar condiciones locales y sistémicas que predisponen al desarrollo de erisipela 6 . La importancia de reconocer estos factores es determinante para evitar un primer episodio o la recurrencia de esta enfermedad.…”

“…Otros factores corresponden a la presencia de insuficiencia venosa, edema de la extremidad, sobrepeso u obesidad. Estos estudios no han logrado demostrar que la diabetes mellitus sea un factor de riesgo independiente 6 . El factor más frecuente en la población es la presencia de intertrigo fisurado.…”

Dermatologia comparativa: similaridade entre elefantíase nostra verrucosa e coral

“…It is an infectious lymphangitis marked by a red skin-rash with a sharply demarcated raised edge, spread along the lymph capillary network and also affecting the lymph nodes. 2 This occurs not only in non-infectious lymphangitis, but also in the recurrent episodes of erysipelas suffered by elderly or immunodepressed patients, due to lymphatic impairment. The exudate of protein, fibrin and figurata elements, as well as endothelial damage causing thrombosis of the lymphatic trunk, eventually leads to edema and lymphedema.…”