4 responses to “Prevention of recurrent cellulitis”

  1. Clarification around there the requirement for prescription stockings. I have found that patients wanting to get the 20-30 mmHg at some pharmacies are required to have a prescription. The over the counter is under 19 mmHg. Often finding that for insurance coverage as well, getting the 20-30 mmHg may require a script for them to be covered.

    In patients with severe peripheral venous insufficiency, stasis dermatitis, or those prone to recurrent cellulitis. I find often the initial treatment of getting them to a dry weight to fit compression stockings the most challenging aspect. Then the limitations with self donning. I think a NNT of 4 is quite encouraging and reinforces current practice of encouraging compression stocking as treatment.

    One of the most limiting challenges with compression stockings in rural BC is access to vascular assessment clinics. Often for in-patients in our rural hospitals there is no one or only 1 person available to perform ABIs. In addition, our home care who previously was able to now only will perform the assessments on chronic, non-healing ulcers, and do not have the resources to provide outpatient assessments.

    Given the impact on QOL of recurrent cellulitis, and the impressive NNT of compression, it may be worth our health system investing in either automated ABI machines for some of the new PCN clinics, incorporating wound care nurses into their practices, or helping fund ABI machines for private clinics to carry out these tests for rural communities with limited access so we can get people started on proven treatment faster and prevent recurrence.

  2. I second the clarification on prescription requirement made by Evan Mah. Though I’m not sure if there is actually any regulation of compression products, suppliers and training programs for fitting compression stockings do advise retailers that anything above 20mmHg requires a “prescription” by a practitioner who has confirmed the need, and ruled out contraindications for higher compression. The highest strength generally available over the counter is 15-20mmHg.

  3. A small reminder to order toe brachial index in diabetic patients.

  4. As we all know 20-30mmHg compression stockings are very challenging to put on and take off for the elderly population living alone so compliance can be a problem.
    Anecdotally I had one patient leave her stockings on for a week or so at a time and ended up with such poor hygiene to her feet and skin that it was a significant contributory factor to the recurrence of her cellulitis.
    I like the idea of pen V bid, NNTs in your article are impressive, thank you for sharing.

Leave a Reply