Risk factors for erysipelas of the leg (cellulitis): case-control study

BMJ 1999;318:1591-1594 ( 12 June )

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Risk factors for erysipelas of the leg (cellulitis): case-control study

Alain Dupuy, senior resident, ^a Hakima Benchikhi, dermatologist, ^a Jean-Claude Roujeau, professor, ^a Philippe Bernard, professor, ^c Loïc Vaillant, professor, ^d Olivier Chosidow, assistant professor, ^e Bruno Sassolas, consultant, ^f Jean-Claude Guillaume, consultant, ^g Jean-Jacques Grob, professor, ^h Sylvie Bastuji-Garin, assistant professor. ^b

^a Dermatology Department, Hôpital Henri Mondor, 94010 Créteil, France, ^b Public Health Department, Hôpital Henri Mondor, ^c Dermatology Department, Hôpital Robert Debré, 51092 Reims, France, ^d Dermatology Department, Hôpital Trousseau, 37044 Tours, France, ^e Dermatology Department, Hôpital Pitié-Salpêtrière, 75013 Paris, France, ^f Dermatology Department, Centre Hospitalier Universitaire de Brest, 29285 Brest, France, ^g Dermatology Department, Hôpital Pasteur, 68024 Colmar, France, ^h Dermatology Department, Hôpital Sainte-Marguerite, 13009 Marseille, France

Correspondence to: Dr Bastuji-Garinsylvie.bastuji-garin{at}hmn.ap-hop-paris.fr

Objective: To assess risk factors for erysipelas of theleg(cellulitis).
Design: Case-controlstudy.
Setting: 7 hospital centres inFrance.
Subjects: 167 patients admitted to hospital for erysipelasof the leg and 294controls.
Results: In multivariate analysis, a disruption ofthe cutaneous barrier (leg ulcer, wound, fissurated toe-web intertrigo,pressure ulcer, or leg dermatosis) (odds ratio 23.8, 95% confidenceinterval 10.7 to 52.5), lymphoedema (71.2, 5.6 to 908), venousinsufficiency (2.9, 1.0 to 8.7), leg oedema (2.5, 1.2 to 5.1)and being overweight (2.0, 1.1 to 3.7) were independently associatedwith erysipelas of the leg. No association was observed with diabetes,alcohol, or smoking. Population attributable risk for toe-webintertrigo was 61%.
Conclusion: This first case-control study highlights themajor role of local risk factors (mainly lymphoedema and siteof entry) in erysipelas of the leg. From a public health perspective,detecting and treating toe-web intertrigo should be evaluatedin the secondary prevention of erysipelas of theleg.

Key messages

Local factors are potential risks for erysipelas of the leg
Lymphoedema and disruption of the cutaneous barrier exhibit the highest relative risk
Toe-web intertrigo has a high population attributable risk, and its detection and treatment may prevent up to 60% of cases of erysipelas of the leg

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