Cellulitis in chronic oedema

Linked Article: Burian et al. Br J Dermatol 2021; 185:110–118. Cellulitis (also known as erysipelas) is a common infection of the skin and subcutaneous tissues, therefore falls within domain dermatologists. Cellulitis, which can often be recurrent, among top 10 reasons for admission to hospital, with patients receiving treatment from many specialties including emergency care, general practitioners, medicine, surgery, tissue viability dermatology.1 In this issue BJD, al.2 examine prevalence cellulitis in chronic oedema. Chronic oedema an easily identified clinical sign leads same pathophysiological effects appearances lymphoedema, not so distinguished. Tissue fluid predominantly drained by lymphatic system venous reabsorption was previously thought.3 This means that all oedema, i.e. persisting at least 3 months, caused either absolute reduction lymph transport, or drainage being overwhelmed (lymph) load, such occurs higher pressures heart failure disease. Therefore, always represents failure, it easy identify has physiological effects, considered surrogate lymphoedema.4 As carries antigen related well lymphocytes appropriate immune response, disturbed drainage, whether owing load vessel dysfunction, results immunodeficiency consequence cell trafficking.5 The novel findings publication are one-third likely develop some point. worse more occur; better less occur. strengths large number included study international collaboration involving nine countries, indicating predisposing global healthcare burden – these countries. By targeting professionals interest lymphoedema patients, numbers may have been falsely elevated severe cases compared population large, but does undermine value results. Unfortunately, data on recurrent were occurrence. shown previously, self-perpetuating past episodes making future likely.6 While prophylactic penicillin preventing cellulitis,6 demonstrates importance controlling cellulitis, finding recently confirmed use compression garments prevent cellulitis.7 So healthcare, treated acute episode discharged without sufficient consideration given risk factors, disease wounds. Dermatologists placed manage conditions should involved care. Norwich model dermatological input cellulitis,8 particularly red legs do mean mismanagement frequently occurs.9 PETER MORTIMER: Writing-original draft (equal).