Background: Recurrent cellulitis is a common condition in patients with lower-extremity edema. Although some clinicians recommend compression garments as a preventative treatment, there are no data evaluating their efficacy for this purpose.
Dr. Michael Herscher
Study design: Participants were randomized to receive either education alone or education plus compression therapy. Neither the participants nor the assessors were blinded to the treatment arm.
Setting: Single-center study in Australia.
Synopsis: Participants with cellulitis who also had at least two previous episodes of cellulitis in the previous 2 years and had lower-extremity edema were enrolled. Of participants, 84 were randomized. Both groups received education regarding skin care, body weight, and exercise, while the compression therapy group also received compression garments and instructions for their use. The primary outcome was recurrent cellulitis. Patients in the control group were allowed to cross over after an episode of cellulitis. The trial was stopped early for efficacy. At the time the trial was halted, 17 of 43 (40%) participants in the control group had recurrent cellulitis, compared with only 6 of 41 (15%) in the intervention (hazard ratio, 0.23; 95% CI, 0.09-0.59; P = .002). Limitations include the lack of blinding, which could have introduced bias, although the diagnosis of recurrent cellulitis was made by clinicians external to the trial. This study supports the use of compression garments in preventing recurrent cellulitis in patients with lower-extremity edema.
Bottom line: Compression garments can be used to prevent recurrent cellulitis in patients with edema.
Citation: Webb E et al. Compression therapy to prevent recurrent cellulitis of the leg. N Engl J Med. 2020;383(7):630-9. doi:10.1056/NEJMoa1917197.
Dr. Herscher is a hospitalist in the Division of Hospital Medicine, Mount Sinai Health System, New York.