Lesson of the week: Importance of distinguishing between cellulitis and varicose eczema of the leg

Differentiating varicose (gravitational) eczema and cellulitis can help reduce morbidity and the costs of hospital stay and antibiotics Dermatologists often see patients with gravitational (varicose) eczema that has been treated unsuccessfully as cellulitis of the leg on medical or surgical wards. It is important to recognise the difference between these two conditions early. This should reduce morbidity and costs, in terms of the length of stay in hospital and the use of expensive intravenous antibiotics for a condition that is not life threatening and can be cleared with topical steroids in a few days. I document two such cases. ### Case 1 An overweight 47 year old woman was admitted to a medical ward. Her right leg had been swollen for four days and was covered with tiny blisters. Her general practitioner had noted that the leg did not look like a “simple cellulitis.” Physical examination showed that the patient's temperature was 37°C and that her right leg was swollen and inflamed and covered in tiny blisters. Other findings were normal. A diagnosis of cellulitis of the right leg was made. Swabs from …