Quirke et al reported risk factors for nonpurulent cellulitis of the lower extremities. Control of local factors are important in managing these patients over time. The authors are from Beaumont Hospital, Royal College of Surgeons in Ireland, National Children's Research Centre and University of Cork in Ireland.
Nonpurulent leg cellulitis features:
(1) bacterial inflammation of dermis and subcutaneous tissues in the lower extremities
(2) without discharge, abscess or purulent drainage
Major risk factors for nonpurulent cellulitis (odds ratios 14 to 40):
(1) history of previous cellulitis (odds ratio 40)
(2) current leg wound (odds ratio 19)
(3) current leg ulcers (odds ratio 14)
Additional risk factors (odds ratios 2.4 to 6.8):
(4) chronic leg edema or lymphedema (odds ratio 6.8)
(5) excoriating skin disease of the legs (odds ratio 4.4)
(6) history of previous leg ulcer (odds ratio 4.5)
(7) tinea pedis with toe web disease (odds ratio 3.2)
(8) body mass index (BMI) > 30 (odds ratio 2.4)
(9) previous leg surgery (odds ratio 2.7)
The presence of diabetes, smoking or alcohol use were not identified as risk factors.
Control issues should address:
(1) body weight
(2) control of diabetes (not identified as risk factor for cellulitis but may affect host response)
(3) any breaks in skin
(4) edema (with compression stockings, etc)
(5) dermatophyte infection
(6) other podiatric issues
