Abstract Number: 25

Recurrent cellulitis

P. Mortimer

Meeting: 2016 Dermcoll

Session Information

Date: -

Session Title: Clinical Updates

Session Time: -

Cellulitis (or erysipelas as it is more usually known in Eur- ope) is one of the most common reasons for emergency admissions to hospital and up to half of patients have

© 2016 The Australasian College of Dermatologists

32 Australasian Journal of Dermatology (2016) 57

repeat attacks. Once attacks become recurrent there is very likely to be an underlying lymphatic insufficiency.

Impaired lymph drainage leads to high rates of infection, particularly cellulitis, within the lymphatic basin. In a com- munity-based survey, 29% of those with lymphoedema (64/218) had suffered cellulitis within the previous 12 months, of which 27% (16/64) required admission for intravenous antibiotics with a mean length of stay of 12 days 1.

The afferent lymphatic vasculature provides the major exit route from the skin for soluble antigens and for immuno- logically active cells (e.g. lymphocytes, dendritic cells and macrophages). It is likely that disturbances in immune cell trafficking compromise tissue immunosurveillance to pre- dispose to infection, but the exact mechanism is not known.

Low-dose prophylactic penicillin, phenoxymethylpenicillin 250 mg twice daily, given for a period of 12 months almost halves the risk of recurrence during the intervention per- iod compared with placebo 2. However, although some level of protection appears to be sustained for several months after the end of prophylactic therapy, this effect is lost by 36 months, a finding that suggests that longer term prophylaxis may be required. Patients with a body mass index (BMI) of 33 or higher, multiple previous episodes of cellulitis or lymphoedema of the leg had a reduced likeli- hood of a response to prophylaxis.

Management of recurrent cellulitis should consider risk factors and prophylactic antibiotics as well as seek to improve lymph drainage3.