Summary
A BMJ editorial says fragmented care and inequities complicate cellulitis management, a condition linked to more than 100,000 hospital admissions annually in England. It highlights frequent misdiagnosis and calls for better diagnosis, health equity and recurrence prevention.
A BMJ editorial published on 18 September 2026 argues that fragmented care and health inequities make cellulitis harder to diagnose and manage. The condition is one of the most common skin and soft tissue infections and is associated with more than 100,000 hospital admissions annually in England.
The article is an editorial rather than a new clinical trial. Its focus is the patient journey: recognising cellulitis accurately, identifying people at higher risk of delayed care, and preventing recurrence after the initial episode.
Why cellulitis is difficult to diagnose
Cellulitis remains a clinical diagnosis, with no validated diagnostic test available. The authors report that approximately 40% of patients eventually receive an alternative diagnosis. A red or inflamed lower limb can be caused by cellulitis, but also by conditions such as stasis dermatitis, eczema, oedema or lymphoedema.
These conditions can occur alongside cellulitis, making the assessment more difficult. The editorial says clinicians may default to cellulitis when faced with an erythematous lower limb because alternative diagnoses are less familiar.
Several possible aids are discussed. Thermal asymmetry—the difference in temperature between limbs—and composite tools such as ALT 70 may help distinguish cellulitis from other causes of lower-limb inflammation. ALT 70 combines asymmetry, leucocytosis, tachycardia and age of at least 70 years. The authors stress that these approaches require further validation before their role can be defined more firmly.
Fragmented care can compound clinical and social barriers
The editorial links poorer cellulitis management with fragmentation across the patient journey. It highlights people who inject drugs as a group experiencing a high burden of cellulitis and delayed help-seeking. This example shows how diagnosis and treatment are shaped not only by clinical signs but also by whether patients can obtain timely care.
The authors argue that improving diagnosis and management should be accompanied by greater attention to health equity and recurrence prevention. In practice, that places the initial diagnosis within a wider care pathway: clinicians need to consider alternative and coexisting skin conditions, while services also need to address barriers that delay presentation and contribute to disconnected care.
The central message is therefore broader than improving recognition during a single consultation. More reliable assessment, attention to unequal access and measures aimed at preventing recurrence all form part of better cellulitis management.