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Risk factors and complications of lower limb cellulitis in Africa: a systematic review
  1. Frank-Leonel Tianyi1,
  2. Clarence Mvalo Mbanga2,
  3. Celestin Danwang3,
  4. Valirie Ndip Agbor4
  1. 1 Department of General Medicine, Mayo Darley Sub-divisional Hospital, Banyo, Cameroon
  2. 2 Department of General Medicine, Mankon Sub-divisional Hospital, Bamenda, Cameroon
  3. 3 Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
  4. 4 Department of General Medicine, Ibal Sub-divisional Hospital, Oku, Cameroon
  1. Correspondence to Dr Valirie Ndip Agbor; nvagbor{at}


Objective To summarise available data on the risk factors, complications and the factors associated with complications of lower limb cellulitis in Africa.

Methods We did electronic searches on PubMed, EMBASE, Scopus and African Journals Online from 1 January 1986 to 30 October 2017, extracted and summarised data on the risk factors, complications and the factors associated with the complications of lower limb cellulitis from eligible literature.

Results A total of seven studies were retained for final review after the search and screening processes. Local risk factors of cellulitis reported were: disruption of the skin barrier, neglected wounds, toe-web intertrigo, leg ulcers, use of depigmentation drugs and leg oedema. Obesity was the only reported general risk factor of cellulitis. Five studies reported on the complications of cellulitis which included: abscess formation, necrotising fasciitis, bullae, haemorrhagic lesions, necrosis, phlebitis and amputations. Nicotine addiction, chronic use of non-steroidal anti-inflammatory drugs, delay in the initiation of antibiotic treatment and elevated erythrocyte sedimentation rate were risk factors of complications of lower limb cellulitis identified from three studies.

Conclusion This review highlights the important role of local risk factors in the pathogenesis of lower limb cellulitis in Africa. The association between voluntary skin depigmentation and lower limb cellulitis should alert public health authorities and the general population to the health risks associated with this practice. The identification and improved management of the risk factors of lower limb cellulitis and its complications could go a long way in decreasing the morbidity and health costs incurred by lower limb cellulitis in Africa.

  • lower limb cellulitis
  • Africa
  • systematic review
  • risk factors
  • complications

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  • F-LT and CMM contributed equally.

  • Contributors VNA conceived the study and searched data. VNA and CD screened and selected eligible full texts. CD and VNA extracted the data. CD, F-LT, CMM and VNA interpreted the data. CMM, FL-T and VNA drafted the initial manuscript. CD, F-LT, CMM and VNA revised the manuscript for intellectual content. All authors approved the final version of the manuscript. VNA is the guarantor of the review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Available data can be obtained by contacting the corresponding author.

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