Compression garments reduced risk of recurrent cellulitis in adults with chronic edema
A randomized trial, which was stopped early for efficacy, showed that compression therapy plus education on cellulitis prevention resulted in a lower incidence of recurrent cellulitis and cellulitis-related hospitalizations than education alone.
The use of compression garments may help prevent recurrent cellulitis and cellulitis-related hospitalizations in at-risk adults, a randomized trial found.
Researchers randomly assigned adult participants with chronic edema of the leg and a history of two or more previous episodes of cellulitis to receive leg compression therapy plus education on cellulitis prevention (compression group) or education alone (control group). All participants received education regarding the benefits of skin care, prevention of interdigital fungal infections, a healthy body weight, and regular exercise. Those in the compression group received free compression garments, which they were instructed to wear throughout the day, rotating between two sets of garments to maintain cleanliness. Follow-up occurred every six months for up to three years or until 45 episodes of cellulitis had occurred in the trial. Participants in the control group who had an episode of cellulitis crossed over to the compression group. The primary outcome was the recurrence of cellulitis, and secondary outcomes included cellulitis-related hospital admission and quality-of-life assessments. Results from a planned interim analysis were published online on Aug. 13 by the New England Journal of Medicine.
Eighty-four participants (mean age, 64 years; 49% women) enrolled in the trial, 41 in the compression group and 43 in the control group. All participants had pre-existing edema, 79% had a body mass index of 33 kg/m2 or greater, and 26% had had three or more episodes of cellulitis in the two years before the trial. At the time of the interim analysis, 23 episodes of cellulitis had occurred in six participants (15%) in the compression group, compared with 17 (40%) in the control group (hazard ratio, 0.23; 95% CI, 0.09 to 0.59; P=0.002) during a median follow-up period of 186 days. The relative risk was 0.37 (95% CI, 0.16 to 0.84; P=0.02) in a post hoc analysis, and the trial was stopped early for efficacy. Overall, three participants (7%) in the compression group and six (14%) in the control group were hospitalized for cellulitis (hazard ratio, 0.38; 95% CI, 0.09 to 1.59). Most quality-of-life outcomes did not differ between groups, and no adverse events occurred during the trial.
The study authors cautioned that for multiple comparisons of secondary outcomes, including hospitalization for cellulitis, lack of a prespecified plan for adjustment precluded clinical conclusions. Other limitations included the trial's nonblinded, single-center design and short duration of follow-up, as well as the participants' high adherence to compression therapy, which may have been the result of support from experienced clinicians and may limit generalizability of the findings, they said.
While randomized trials have supported antibiotics as prophylaxis for cellulitis of the leg, all participants in the trial had one or more risk factors for antibiotic prophylaxis failure, the authors added. “Compression therapy could potentially decrease the risk of cellulitis by lessening edema, improving immune response and skin integrity, and providing physical protection for the skin. … Larger and longer trials are necessary in order to determine the effect of compression therapy on the recurrence of cellulitis, especially in settings without access to specialized lymphedema services,” they wrote.