From the Guidelines
Bilateral leg erythema and inflammation are most commonly caused by cellulitis, a bacterial skin infection, or stasis dermatitis due to venous insufficiency, with treatment depending on the underlying cause. The causes of bilateral leg erythema and inflammation can be multifactorial, including:
- Cellulitis, a bacterial skin infection typically presenting with warmth, tenderness, and spreading redness, often caused by streptococci or staphylococci 1
- Stasis dermatitis, resulting from venous insufficiency, where blood pools in the legs causing redness, swelling, and sometimes itching or pain
- Contact dermatitis, caused by skin exposure to irritants or allergens
- Vasculitis, involving inflammation of blood vessels, which can cause purplish rashes
- Deep vein thrombosis, presenting with unilateral or bilateral leg swelling, warmth, and redness
- Systemic conditions like lupus or rheumatoid arthritis, which can also cause bilateral leg inflammation According to the most recent guidelines, antibiotics against Gram-positive bacteria are recommended for the treatment of cellulitis and erysipelas 1. Additionally, elevation of the affected area and treatment of underlying conditions, such as tinea pedis or venous eczema, are crucial for managing cellulitis 1. In cases of suspected MRSA, glycopeptides and newer antimicrobials are the best options 1. Proper diagnosis is essential, typically requiring physical examination and sometimes additional testing like ultrasound, blood tests, or skin biopsy to determine the specific cause and appropriate treatment. It is also important to note that each attack of cellulitis can cause lymphatic inflammation and possibly some permanent damage, leading to lymphedema 1. Therefore, measures to reduce recurrences of cellulitis, such as treating interdigital maceration and keeping the skin well hydrated, are crucial for preventing long-term complications.
From the Research
Causes of Bilateral Leg Erythema and Inflammation
- Bilateral leg erythema and inflammation can be caused by various factors, including infections, inflammatory diseases, and systemic conditions 2, 3, 4, 5, 6
- Erysipelas, a common skin infection, can cause bilateral leg erythema and inflammation, especially if there is an underlying lymphatic dysfunction 2
- Erythema nodosum, a type of panniculitis, can also cause bilateral leg erythema and inflammation, and is often associated with systemic diseases such as tuberculosis, sarcoidosis, and inflammatory bowel disease 4, 5, 6
- Streptococcal infections are a common cause of erythema nodosum, and can also contribute to bilateral leg erythema and inflammation 3, 4, 5, 6
Lymphatic Dysfunction and Bilateral Leg Erythema
- Lymphatic dysfunction can contribute to bilateral leg erythema and inflammation, as it can lead to impaired lymphatic drainage and increased susceptibility to infections 2
- A study found that patients with erysipelas often have signs of pre-existing lymphatic impairment in the unaffected leg, suggesting that subclinical lymphatic dysfunction may be an important predisposing factor for bilateral leg erythema and inflammation 2
Systemic Conditions and Bilateral Leg Erythema
- Systemic conditions such as tuberculosis, sarcoidosis, and inflammatory bowel disease can cause bilateral leg erythema and inflammation, often through a hypersensitivity response 4, 5, 6
- Erythema nodosum can be a sign of an underlying systemic disease, and a diagnostic algorithm can help identify the underlying cause and guide treatment 5