One of the interesting things about healthcare is that diseases don’t stay the same. We’re seeing more high blood pressure but fewer heart attacks and bowels are definitely causing more bother with an increase in bowel cancer in young people and a huge increase in diverticulitis in middle-aged people due to poor diets.

One condition that used to be uncommon and has more than doubled in incidence in the last 20 years is cellulitis of the legs. Cellulitis is an infection of the skin which mostly occurs below the knees and although it can usually be treated by GPs, it can develop into sepsis and become a life-threatening condition in rare cases.

Patients usually present with a red, swollen leg in the calf area and this can develop slowly over days or weeks, but can be rapid in a few hours in exceptional cases. It’s usually older folk that get this and it’s more common in overweight people with pre-existing skin conditions. It isn’t always painful but the red inflammation is on one leg and if the inflammation is on two legs, it’s probably not cellulitis.

In most cases a GP will treat the condition with the course of oral antibiotics but in more severe cases patients need admitted to hospital for a drip and intravenous antibiotics.

placeholder image — Derry GP Dr Tom Black.

The diagnosis isn’t always easy because there’s no blood test that helps and we have to rely on a clinical diagnosis from the GP. This is a recurrent illness in some patients and they often become expert in their own presentation and treatment regime. I had a patient a few years ago who gets this problem frequently and we discussed treatment options; “no doctor” he said “the oral antibiotics won’t work for this as I’ve left it too late; I need an IV“ so I called for an urgent ambulance. Within 20 minutes I had to upgrade to a blue lights ambulance as he had deteriorated rapidly. He was right and I was glad I listened to him! There’s about 21 other conditions that cause these symptoms such as phlebitis, bursitis, vasculitis or a clot in a deep vein. One which you don’t see very often now was erythema abigne which affected grannies years ago if they sat too close to the fire and developed chronic inflammation of their shins. If you’ve had cellulitis and you want to avoid a recurrence which can happen in up to half the cases the best thing to do is to lose weight, improve your diet, try to avoid swelling in the lower legs and make sure your skin and feet are well looked after as a break in the skin can let in bacteria to cause the infection. A course of oral antibiotics will clear most cases and blood tests are usually not needed unless the condition becomes more severe and hospital admission is needed. For those patients with recurrent infection there’s some evidence that compression bandages can help or a routine preventative antibiotic. This condition will become much more common over the next couple of decades due to the increase in the number of older people with pre-existing illnesses and there have been more than 100,000 hospital admissions in the last year in the UK for this.