Compression Therapy Cuts Cellulitis Risk in Chronic Leg Edema.
For patients with chronic leg edema and recurrent cellulitis, risk for future cellulitis is reduced by 77% by wearing compression stockings or wraps, researchers report. The effect was so striking that the randomized controlled trial was stopped early and all patients in the study were given the therapy.
“In a climate of increasing antibiotic resistance, we are delighted to have discovered a nondrug management strategy that has such a dramatic impact on the risk of cellulitis,” senior author Bernie Bissett, PhD, from the Discipline of Physiotherapy, Faculty of Health, the University of Canberra, Australia, told Medscape Medical News.
“We hope this leads to a shift in preventative medical strategy for patients with chronic edema and cellulitis around the world,” she said.
Lead author Elizabeth Webb, MPH, from the Physiotherapy Department at Calvary Public Hospital Bruce, in Bruce, Australia, and colleagues report their findings in an article published online August 12 in The New England Journal of Medicine.
Bisset explained that Webb is a “leading lymphedema physiotherapist” and a PhD candidate at the University of Canberra. She added that this is the first study to show that “compression therapy dramatically reduces the risk of cellulitis for patients with chronic edema.”
Cellulitis is a common bacterial infection that affects the skin and subcutaneous tissue. It occurs primarily in the legs and frequently recurs. Penicillin is often given preventively; some research suggests effectiveness wanes after the antibiotic is stopped.
For the current trial, Webb and colleagues enrolled 84 adults with chronic edema of the leg and recurrent cellulitis. They randomly assigned patients in a 1:1 ratio to receive leg compression therapy plus education about preventing cellulitis (compression group; n = 41) or education only (control group; n = 43).
Compression therapy consisted of wearing knee-high stockings that applied maximum compression at the ankles. The compression gradually decreased up the legs. In addition, 26 patients were treated with “therapist-applied compression bandaging” for 3 to 5 days before receiving the stockings.
Participants underwent follow-up assessments every 6 months for a maximum of 3 years or until 45 episodes of cellulitis, the primary outcome, occurred. Those in the control group crossed over to the compression group once they experienced cellulitis.
The trial was stopped early for reasons of efficacy. “The statistical analysis plan prespecified that after 23 episodes of cellulitis had occurred, an independent data monitoring committee would review the results of the interim analysis and recommend whether the trial should stop early,” the authors write.