Don’t routinely prescribe antibiotics for bilateral lower leg redness and swelling.

Cellulitis is commonly misdiagnosed and may be incorrectly applied as a diagnosis in 1 in 3 cases. There are many causes of ‘pseudocellulitis’, including: stasis dermatitis, acute lipodermatosclerosis, lymphedema, eczematous dermatitis, contact dermatitis, gout and tinea pedis. The most common among these is stasis dermatitis which generally affects the bilateral lower legs. In the setting of bilateral lower leg skin changes, causes of ‘pseudocellulitis’ should be considered.
For more information:

Levell NJ, et al. Severe lower limb cellulitis is best diagnosed by dermatologists and managed with shared care between primary and secondary care. Br J Dermatol. 2011 Jun;164(6):1326-8. PMID: 21564054.

Baibergenova A, et al. Hospitalizations for cellulitis in Canada: a database study. J Cutan Med Surg. 2014 Jan-Feb;18(1):33-7. PMID: 24377471.

Ko LN, et al. Effect of Dermatology Consultation on Outcomes for Patients With Presumed Cellulitis: A Randomized Clinical Trial. JAMA Dermatol. 2018 May 1;154(5):529-536. PMID: 29453872.

Hirschmann JV, et al. Lower limb cellulitis and its mimics: part II. Conditions that simulate lower limb cellulitis. J Am Acad Dermatol. 2012 Aug;67(2):177.e1-9. PMID: 22794816.