Challenges and facilitators in the diagnosis of lower‐limb cellulitis

Summary Cellulitis is a common skin infection seen in the UK, with most cases affecting the lower limbs. It can be a challenging diagnosis to make, with one in three cases initially suspected as being cellulitis then being diagnosed as something different after further assessment. This can lead to unnecessary antibiotics being given and unnecessary hospital stays. Making a correct diagnosis at the outset is important both to patients and clinicians. This study aimed to identify the challenges of, and help available for, diagnosing cellulitis on the lower limb. The authors, based in Nottingham, UK, carried out a review of existing research and grouped the results into key topics. These topics were: 1) alternative diagnoses of suspected cellulitis 2) aids that have been developed to help diagnosis and 3) services that have been developed to help diagnosis. The authors identified multiple alternative final diagnoses for patients who were investigated for suspected cellulitis. The symptoms in these patients overlapped with typical features of cellulitis. Four studies looked at blood tests, scans or a set of rules to help detect cellulitis and two services had been developed to help reduce an inaccurate diagnosis. The present study showed the range of other diagnoses that clinicians need to consider when a patient presents with possible cellulitis. Future work is needed to further assess the efficacy of aids and services that have been developed. Interviews both with patients and clinicians on ways to make an initial diagnosis more accurate would be a beneficial part of further research.