Cellulitis

Question 1

What is cellulitis?

Answer 1

Cellulitis is an acute bacterial infection of the dermis and subcutaneous tissue causing inflammation of the skin and systemic illness.

Question 2

Which children are at increased risk of developing cellulitis?

Answer 2

Children with eczema or other skin conditions, immunodeficiency, diabetes, obesity, athlete’s foot, or breaches in the skin barrier.

Question 3

Which organisms most commonly cause cellulitis?

Answer 3

Streptococcus species and Staphylococcus species, with Streptococcus pyogenes being the most common cause.

Question 4

How do bacteria typically enter the skin in cellulitis?

Answer 4

Through breaches in the skin barrier such as trauma, scratches, insect bites, ulcers, or pre-existing skin disease.

Question 5

What are the typical skin features of cellulitis?

Answer 5

Erythema, swelling, warmth, tenderness, and poorly demarcated margins.

Question 6

What systemic features may be present in cellulitis?

Answer 6

Fever, malaise, and regional lymphadenopathy.

Question 7

What key feature helps distinguish cellulitis from erysipelas?

Answer 7

Cellulitis has poorly defined margins, whereas erysipelas has well-defined, raised borders and more superficial involvement.

Question 8

What features raise concern for necrotising fasciitis rather than cellulitis?

Answer 8

Severe pain out of proportion to examination, rapidly spreading erythema, systemic toxicity, crepitus, and skin necrosis.

Question 9

How can cellulitis be differentiated from contact dermatitis?

Answer 9

Contact dermatitis is itchy, often bilateral, linked to an identifiable trigger, and lacks systemic features.

Question 10

When should septic arthritis or osteomyelitis be considered instead of cellulitis?

Answer 10

When there is focal joint or bone pain, reduced joint movement, or an effusion with overlying erythema.

Question 11

What bedside assessments are performed in suspected cellulitis?

Answer 11

Observations including temperature, heart rate, and assessment for systemic illness.

Question 12

Which blood tests are useful in cellulitis?

Answer 12

Full blood count and CRP to assess inflammation, and blood cultures if systemic infection is suspected.

Question 13

When is imaging indicated in cellulitis?

Answer 13

If an abscess, deep infection, or osteomyelitis is suspected, or if there is poor response to treatment.

Question 14

When should a skin swab be taken in cellulitis?

Answer 14

If there is a wound, ulcer, or discharge to guide antibiotic choice.

Question 15

How is cellulitis treated?

Answer 15

With oral or intravenous antibiotics depending on severity, commonly flucloxacillin or cephalosporins, with clindamycin as an alternative.

Question 16

What conservative measures should be used alongside antibiotics?

Answer 16

Analgesia, elevation of the affected limb, and marking the area of erythema to monitor spread.

Question 17

When is intravenous antibiotic therapy indicated in cellulitis?

Answer 17

In severe infection, systemic illness, immunocompromised patients, or failure of oral therapy.

Question 18

When is surgical management required in cellulitis?

Answer 18

If there is abscess formation, necrosis, or failure to respond to medical treatment.

Question 19

What complications can arise from cellulitis?

Answer 19

Abscess formation, necrotising fasciitis, osteomyelitis, sepsis, and streptococcal toxic shock syndrome.

Question 20

What is the prognosis of cellulitis?

Answer 20

Most cases respond well to antibiotics with full recovery.

Question 21

How can recurrence of cellulitis be reduced?

Answer 21

By treating underlying skin conditions, preventing skin breaks, and managing risk factors.