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