07/31/2026
Up to 30% of cellulitis diagnoses are wrong — and the most common look-alike is stasis dermatitis: inflamed skin from poor venous return, not a bacterial infection (Weng et al., JAMA Dermatology, 2017). That misdiagnosis pattern is estimated to drive 50,000–130,000 unnecessary hospitalizations and $195–515 million in avoidable U.S. healthcare spending every year.
The two conditions get lumped together because they present similarly at a glance: a red, swollen lower leg. The differences are consistent, though. Cellulitis tends to be unilateral, acute (hours to days), hot, tender, and sharply bordered, often with fever or malaise. Stasis dermatitis tends to be bilateral, chronic (weeks to years), itchy rather than tender, and marked by hemosiderin staining, scaling, and lipodermatosclerosis rather than a spreading border. One more tell: stasis dermatitis improves with leg elevation; cellulitis doesn't.
Chronic, bilateral presentations that improve with elevation point toward venous disease more often than infection. For cases that don't fit a clean pattern, early dermatology or vascular referral has been shown to improve outcomes (Li et al.; Ko et al., JAMA Dermatology, 2018).
