Compression Therapy and Recurrent Leg Cellulitis

Compression therapy seems to prevent recurrent leg cellulitis better than conservative management, according to a trial in the New England Journal of Medicine.

It is a known fact that chronic edema of the leg is a risk factor for cellulitis. Daily use of compression garments on the leg has been recommended to prevent the recurrence of cellulitis, but there is limited evidence from trials regarding its effectiveness.

With this background, Elizabeth Webb and associates carried out a trial to investigate whether compression therapy was an effective therapy for preventing chronic and recurrent cellulitis.

The study was a single-center, randomized, non-blinded trial and consisted of 183 patients with chronic edema of the leg and recurrent cellulitis, in a 1:1 ratio, to receive leg compression therapy plus education on cellulitis prevention (compression group) or education alone (control group). Follow-up occurred every 6 months for up to 3 years or until 45 episodes of cellulitis had occurred in the trial. The primary outcome that was assessed was the recurrence of cellulitis. Participants in the control group who had an episode of cellulitis crossed over to the compression group. Secondary outcomes included cellulitis-related hospital admission and quality-of-life assessments.

Key Results

• At the time of a planned interim analysis, when 23 episodes of cellulitis had occurred, 6 participants (15%) in the compression group and 17 (40%) in the control group had had an episode of cellulitis.
• A total of 3 participants (7%) in the compression group and 6 (14%) in the control group were hospitalized for cellulitis (hazard ratio, 0.38; 95% CI, 0.09 to 1.59).
• Most quality-of-life outcomes did not differ between the two groups.
• No adverse events occurred during the trial.

The standard treatment for chronic edema includes compression therapy and skin care. Compression bandaging can be used to reduce edema in a limb, and daily wear of compression garments is used to control edema. There is a consensus that in addition to antibiotic prescription, compression to manage edema should be an adjuvant treatment for patients with chronic edema who are experiencing cellulitis recurrence.

"In this small, single-center, nonblinded trial involving patients with chronic edema of the leg and cellulitis, compression therapy resulted in a lower incidence of recurrence of cellulitis than conservative treatment." said the authors.

Primary source: New England Journal of Medicine.

For further reference log on to: N Engl J Med 2020; 383:630-639