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Skin differentials – Leg cellulitis vs venous eczema

The latest in our series by GP and hospital practitioner Dr Andy Jordan on differentiating two often similar-looking skin conditions

Cellulitis of lower leg


• Occurs in adults – more likely in the elderly

• Associated with fever and malaise, which usually precede the skin changes

• Usually occurs very suddenly and area of erythema increases rapidly from day to day

• Swelling may be severe and blistering and necrosis may occur

• Unilateral – very rarely bilateral

• Tender rather than itchy

• Often there is a portal of entry, for example macerated web spaces on feet or old scar (as pictured here)

• Treated with oral or intravenous antibiotics

• Tinea pedis, if present, should be treated to reduce risk of recurrence

• Recurrent cellulitis requires prophylactic antibiotics to reduce risk of lymphoedema.

Varicose eczema

• More common in – but not exclusive to – middle-aged or elderly women

• Often associated with varicose veins

• Erythematous scaly eruption with oedema, purpura and haemosiderin deposition

• Exudates sometimes occur and ulceration may arise

• May occur suddenly or insidiously

• Secondary patches of eczema may develop on the other leg even when it is not obviously affected by venous insufficiency

• Itchy

• No portal of entry

• Treatment is by compression bandaging or topical, moderately potent steroids and emollients.

Dr Andy Jordan is a GP and hospital practitioner in dermatology in Chesham, Buckinghamshire

Varicose eczema Varicose eczema Cellulitis of the leg Cellulitis of the leg