Is it cellulitis? The case of itchy red legs

66 year old woman with 12 month history of itchy red  legs.

She dated the start of the problem from an excision of a skin lesion from the left shin.  She notes persistent redness occurring over both lower legs, more marked on the left side, and this has been associated with marked itchiness after showering.  She was receiving antibiotics for a presumed cellulitis and also had been using a topical steroid cream.

Past history of bilateral vein stripping years ago and she experiences a degree of swelling in both lower legs that arises through the day and both the swelling and redness settles overnight.  No history of claudication nor other sort of leg pain or paraesthesia. Background of stable hypertension on medication.   

On examination there was noticeable pigmentation over both lower legs with much solar skin damage and moderate pitting peripheral pedal oedema to the ankles bilaterally.  The skin was red and shiny with areas of excoriation on both sides (photos). No tenderness nor warmth was present to suggest cellulitis. 

Diagnosis:  venous stasis dermatitis which has been worsened by pruritis and scratching.  [Stay tuned for a further photo update!]. The shininess indicates loss of the stratum corneum. Redness comes from disordered vascular tone and venous hypertension.

  • She was advised on a skin care routine that includes use of a sorbolene with glycerine 10% barrier cream PRIOR to bathing.  Also apply a further layer after shower.
  • Encouraged to avoid any scratching or rough toweling and use of an oil of primrose dietery supplement for four weeks.
  • Antibiotics and steroid cream ceased.

Note: many do not realise that the major action of ‘moisturiser’ creams is their action as a barrier to prevent further loss of essential skin fatty acids during exposure to hot water and/or soap.  The itch following showering is evidence of the irritability of skin that lacks its normal stratum corneum. 

stasis derm3 stasis derm2

stasis derm1

References

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