Battle deserves another look

Dear Dr Roach: I am having a lengthy battle with cellulitis on my lower leg. For nearly three months, nothing has worked. The inflammation and skin discoloration have not abated even with injections of antibiotics and antibiotic pills. I have soaked my leg in Epsom salt, used antibiotic creams, Vicks rub, aspirin for inflammation, raised my leg when I am sitting. The doctors I have seen have thrown up their hands. An ultrasound showed no blood clot.

This occurred after a 15-hour plane flight and a subsequent day of walking. I wore support hose on the flight and moved as much as possible. There was no break in the skin nor insect bite that I was aware of. I am female, 75, in good health, not obese, do not have any circulation problems.

I know that an infection is very dangerous and can lead to sepsis. — T.E.

Cellulitis, infection of the deeper tissues of the skin, is a common infection. Not everything that looks like cellulitis is an infection, however, and when several courses of antibiotics have failed, it’s time to reconsider the diagnosis.

Looking for a blood clot was wise; blood clots can cause redness and swelling that looks very much like cellulitis sometimes. A deep tissue abscess can prevent cure with antibiotics, but should be apparent.

A wound care nurse colleague of mine with far more experience than me suggested the possibility of acute lipodermatosclerosis, which is a noninfectious inflammation of the deep skin. It happens more commonly in people with poor venous drainage of the legs. The airplane flight and walking is a setup for exacerbating any venous insufficiency. This condition is diagnosed by a wound care expert or dermatologist, and is usually treated by steroid creams and compression. It can frequently be misdiagnosed in its early stage.