FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

IT'S SWOLLEN, IT'S RED, IT'S HOT IT'S CELLULITIS!

Question: I developed what my doctor diagnosed as cellulitis in my lower legs following a second heart attack over two years ago. There were two blisters which drained (apparently water) and healed rapidly, but the pain, redness and swelling in my legs still exists. What causes cellulitis?

Answer: Cellulitis produces inflammation of the skin and the subcutaneous or connective tissue immediately beneath it. This process begins with an infection that causes swelling and redness in the area. The inflammation, in turn, makes the swollen area feel hot to the touch. The infection usually begins from minor scrapes or other injuries to the skin. However, often no specific skin injury or wound is ever found. The blisters you reported are an uncommon but not rare part of cellulitis.

Athlete's foot or other chronic infections of the skin may be the site where bacteria responsible for causing cellulitis enter the body, but I'd guess that your condition resulted from another predisposing factor.

Chronic swelling in the legs without inflammation can greatly increase the chance of having cellulitis. Two common causes of chronic leg swelling are poor circulation because of difficulty with veins, and poor circulation because of heart disease. Your two previous heart attacks make it likely that your cellulitis resulted from chronic leg swelling that was, in turn, a consequence of your heart disease.

Cellulitis is an infection, and therefore, it is treated with antibiotics. In mild cases, antibiotics taken by mouth may be sufficient to clear up the infection. More severe cases often require hospitalization and the use of stronger intravenous antibiotics. It usually requires several weeks of antibiotic treatment followed by several more weeks of healing for the redness and swelling caused by cellulitis to subside. Noting that you have had leg swelling and pain for two years (since your last heart attack), I think it is unlikely that the continuing problem is due to cellulitis.

I don't have a crystal ball to look into the past and foretell the future, but my educated guess is that two years ago you had an episode of cellulitis the episode with the blisters you mentioned that cleared up with the treatment your doctor prescribed. Now, you probably have chronic leg swelling as a consequence of your heart disease or because of "bad veins" in you legs.

The redness and pain of chronic leg swelling can be very similar to signs and symptoms of cellulitis, but the treatment is much different. I'd recommend that you talk to your family doctor again or a specialist in vascular disease about your condition.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.