Flucloxacillin should be used rather than Pen V or ampicillin. An alternative to flucloxacillin or macrolides is clindamycin 300 mg qds (though note the risk of colitis).

Differential diagnoses include varicose eczema, erythema nodosum, DVT, acute oedema, and something called lipodermatosclerosis (which is caused by venous insufficiency and usually presents chronically but can come on in an acute form mimicking sclerosis). Points in favour of it being varicose eczema rather than cellulitis include:

  • Bilateral
  • Dry scaly skin
  • Systemically well patient
  • Signs of venous incompetence
  • Pruritus

Up to 50% of patients who get a first attack will get another. Risk factors for recurrence include:

  • Fungal infection of the lower limb
  • Diabetes
  • Peripheral arterial disease
  • Venous insufficiency
  • Lymphoedema
  • Ulcers
  • Eczema

Some work has been done on using long-term antibiotic treatment (1 – 2 yrs) to prevent further episodes, but results are not conclusive.


(Pulse on-line learning module)


About Dr Sarah

I'm a GP with a husband and two young children.
This entry was posted in Dermatology, Infectious Diseases. Bookmark the permalink.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s