RED LEGS
RED LEGS
Bilateral both leg "cellulitis" - it is EXTREMELY RARE to have a primary bilateral infectious origin.
Most do not require prolonged courses of intravenous or even oral antibiotics. In the absence of significantly raised CRP/WCC overt skin infection cellulitis is unlikely
The commonest causes for bilateral swollen red legs are ? Venous/varicose eczema Early lipodermatosclerosis Peripheral oedema induced secondary skin changes
If symptoms of presumed cellulitis not improving with 48 hours of antibiotics, consider alternative diagnosis as above.
For further information see:
Bilateral Red Legs
Acute/new Diagnosis
Normal CRP/WCC
Consider acute peripheral oedema
Treat medical causes
Skin changes: Dermatitis, varicose veins, haemosiderin, superficial ulcers
Likely venous stasis/dermatitis
If systemically unwell + fever
consider admission to
hospital
Treatment An antibacterial emollient
(eg Dermol/Eczmol) +Trial of topical steroid bd (eg Betnovate RD 0.025%)
Elevation and consider light compression bandage/hosiery Stop abx if started
Systemically well but significantly raised CRP/WCC
Chronic
Treat empirically with oral abx as per formulary
or refer through CCC for consideration of Community IV abx depending on presentation
If no improvement consider routine referral
to Dermatology
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