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Compression Therapy for Cellulitis Prevention

Chronic swelling (also referred to as “edema”) in the legs is a risk factor for eventually developing cellulitis. A recent study showed that swelling of the legs from any cause leads to an increased risk for leg skin infections or cellulitis. For women suffering from Lipedema, this can add insult to injury in an already debilitating disease accompanied by sensitive and easily bruised skin. If left untreated, cellulitis can move into the lymph nodes and bloodstream and require more serious medical treatment. Symptoms of cellulitis may include the following:

  • Red area of skin that tends to expand
  • Swelling
  • Tenderness
  • Pain
  • Warmth
  • Fever
  • Red spots
  • Blisters
  • Skin dimpling

Today, most doctors recommend conservative and preventative measures, such as daily washing of wounds or cuts that could be infiltrated by bacteria, and the application of protective creams, ointments, and bandages when necessary to surface wounds or extremely dry, flaky skin. Preventative medications, such as antibiotics, may be recommended in some instances where patients experience several recurrences of cellulitis.

For people with poor circulation – such as diabetics or women with Lipedema or Lymphedema, additional precautions for avoiding skin injury are recommended, but overall are still conservative and focus on healthy and consistent skincare. For example, the health providers at the Mayo Clinic recommend you inspect your feet daily, to check for signs of injury or infection early on, moisturizing skin regularly to avoid dryness or cracks, trimming finger and toenails with great care to avoid injuring the skin and wearing clean and protective footwear and gloves often.

Like Lipedema, there’s a lot we still don’t know about cellulitis; we know it can be caused by several types of bacteria infecting deeper layers of the skin, we know that it causes swollen, red, painful areas in the skin, and we know it commonly affects the feet and lower legs. But we don’t know how the bacteria gets into the body for many people affected. And new studies suggest something else we did not know previously – compression therapy may help prevent this painful condition.

A recent study by the New England Journal of Medicine divided 84 patients into two groups. Participants in each group experienced chronic swelling in their legs, and also suffered from cellulitis on an ongoing basis. In the first group, participants received compression therapy and were provided education on how to prevent their cellulitis from returning. In the second group, participants received the same education but did not undergo compression therapy. The groups returned for follow-up therapy and education every six months, for up to three years, until the entire trial experienced a total of 45 cases of cellulitis. When someone in group two experienced a return of their cellulitis, they were moved to group one to under compression therapy. 

Overall, the quality of life in both groups was the same, and there weren’t drastically different experiences between group one and group two. However, the group who received both therapy and cellulitis prevention education experienced only 6 new cases of cellulitis, while the second group experienced 17 cases. While the study was small, and additional studies are needed, early indications suggest compression therapy will result in lower recurrence of cellulitis than education and conservative treatments alone. We have known for years that people with lymphedema have an increased risk for cellulitis and they benefit from compression. However, this study showed leg swelling from any cause puts affected individuals at risk for infections, and that compression helps reduce this risk. 

For patients with Lipedema, there are many reasons to consider using compression garments or compression pumps.  For individuals who have lipedema, lymphedema, or lipo-lymphedema, compression garments are often used to assist the lymph circulation by increasing the pressure in the tissue to propel lymph fluid through the body. Lymphedema causes excess fluid to become trapped in the extremities, especially the legs, and compression garments put pressure on the skin and veins, helping them clear lymph and decongest. If we can utilize the garments to decrease the levels of chronic edema, we may also decrease the chances of developing cellulitis. 

Compression garments can help reduce pain and heaviness felt in the limbs from fat disorders (such as lipedema) by decreasing swelling in the fat and throughout the limbs. Compression may also reduce the rate at which the fat cells grow, and help to prevent fat disorders from progressing to more serious stages. In other words, compression can be one of the best treatments for lipo-lymphedema or fat caused by lymphatic diseases, in addition to cellulitis prevention.

Another option patients have to manage their own symptoms at home is pneumatic compression pumps. Pneumatic compression pumps are a great at-home solution for patients suffering from lipedema or lymphedema, and potentially for cellulitis prevention. Compression pumps are devices that mimic the massage techniques used in manual lymphatic drainage. An intermittent pneumatic compression device (IPC) is worn on the affected limb and activated to help push retained fluids back towards the core of the body. These devices let patients who may have difficulty or are unable to visit a doctor’s office often still find relief from their symptoms.

If you have compression stockings but they aren’t providing enough relief, an intermittent pneumatic compression device can help you get daily treatment.  These treatments are very effective at treating extreme levels of swelling, and IPC devices help patients to continue their treatment at home and keep their lymph fluid from rebuilding in the affected limbs. As we continue to monitor the development and new studies related to how these practices may help prevent the recurrence of cellulitis, we will update the data here as well. 

You can read more about compression garments and compression pumps here. The full study is below. 

NEJM Compression Cellulitis Swollen Legs