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Differentiating between red legs and cellulitis

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 Deep vein thrombosis Deep vein thrombosis seen in the left leg of the patient; her right leg appears normal

Red legs is a condition commonly seen in patients with chronic venous disease (CVD), chronic oedema, or lower-limb dermatological conditions. It is often misdiagnosed as cellulitis.1 Studies have shown that around 28%-33% of patients treated for cellulitis are misdiagnosed, which subsequently leads to avoidable and costly hospitalisation and potentially hazardous use of intravenous antibiotics that may compound the evolution of antibiotic-resistant bacteria.2,3 Over a period of seven years, there has been an increase of 77% in the number of people admitted to hospital for management of lower-limb cellulitis,4 costing the NHS between £172-£254 million per year.5 The aim of this article is to raise awareness of red legs and highlight the differential diagnoses. As a result, nurses may be able to avoid misdiagnosing cellulitis and improve a patient’s experience, as well as avoid costly hospitalisation and antibiotic therapy.

What are red legs?
Red legs is typically presented with redness that affects both legs, normally in the lower limbs, and is accompanied by warmth and tenderness in the area. There is generally no systemic upset or malaise. The symptoms are commonly accredited to chronic inflammatory changes caused by dermatological and venous conditions such as vascular eczema, lipodermatosclerosis, tinea pedis,

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Very interesting and informative article: I have been diagnosed with lower leg, unilateral cellulitis four times in the last 18 months; I've also recently had impetigo, boils & a stye. My legs are still sore and tender: but I'm worried about having flucloxicillin so frequently, that resistance might occur ... I will now go back to my GP & request microbiology before any more antibiotics, and try to moisturise with Zerocream daily. This info should be more widely available! Thanks so much
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Very good reading and educational,my husband has seen DR.for a couple of years for the red patch, keep creaming that's what been told!! Two days ago it was turned very hot and red ,than 111 advice to go to A&E suspect blood clots ok!! We went to A&E, after a few hours of blood test and questions and answers,we came home with antibiotics to take. this morning his leg still very hot and red just hope antibiotics work next 48 hours!!! After reading the article I now know a bit more about what could it be!!! Just try living healthy!!!! Thanks
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I am delighted to read this article. In my practice as Director of a Wound Healing Company and a Tissue Viability Consultant Nurse, it is absolutely amazing how many people I see that have been having antibiotics for months for an 'infection' and when I apply some steroid ointment, the redness is gone within a few days.
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Thank you for this article. My Mother (91) has had redness and swelling in her legs for many years. She suffers from Pagets disease (mainly manifests itself in the right leg) and arthritis, and has had inconsistent treatment, if any, for the redness and swelling. I suspect this is due to it being thought that 'it is your age' . Having read this article I now feel it is important to revisit her medical care and not accept the status quo, and push for a coordinated aporoach to improve her condition.
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Thank you, I will quote this in my lecture to GPs. I am working with Dr Jungkunz to look at skin using ultrasound for the differential diagnosis of various leg disorders/disease, and the proving the effect of compression to prevent lipodermatosclerosis
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