Cellulitis

Question 1

What is cellulitis?

Answer 1

infection of deep dermis and subcutaneous tissue

Question 2

What is erysipelas?

Answer 2

infection of more superficial tissue

Question 3

How can you tell if cellulitis?

Answer 3

acute spreading infection of the skin with visually indistinct borders

Question 4

What are RF for cellulitis?

Answer 4

1. Diabetes
2. Venous insufficiency
3. Eczema
4. Oedema and lymphoedema
5. Obesity
6. Previous episodes of cellulitis
7. Toe-web abnormalities
8. IV cannula
9. Wounds, ulcer, bites
10. Immunosuppresion

Question 5

What is most common cause of cellulitis?

Answer 5

1. Staph aureus
2. Beta-haemolytic streptococci
   (Strep pyogenes)

Question 6

What are the symptoms and signs of cellulitis?

Answer 6

acute onset of red, painful hot swollen skin

Question 7

What are symptoms and signs of erysipelas?

Answer 7

well-demarcated bright-red raised skin

Question 8

What are differential diagnosis for cellulitis?

Answer 8

1. Necrotising fascilitis
2. Thrombophlebitis, superficial
3. DVT
4. Gout
5. Lyme disease
6. Contact dermatitis
   Etc

Question 9

What investigations of cellulitis?

Answer 9

• Consider swab and aspiration cultures if cellulitis is associated with a break in skin
  1. FBC: high WCC
  2. ESR
  3. CRP: high
  4. Urea and Electrolytes
  5. Blood culture and sensitivities

Question 10

What is the management for cellulitis?

Answer 10

• CHECK IF SEPSIS

- Antibiotic therapy: e.g. amoxicillin (oral or IV) + analgesia

Question 11

What are possible complications of cellulitis?

Answer 11

1. Sepsis
2. Chronic oedema in affected extremity
3. Abscess
4. Sepsis
5. NecFasc
6. Periorbital and Orbital cellulitis:

Question 12

What is the difference in site for cellulitis and erysipelas?

Answer 12

1. Cellulitis: dermis, subcutaneous tissue

2. Erysipelas: epidermis

Question 13

What is the difference in borders for cellulitis and erysipelas?

Answer 13

1. Cellulitis: more patchy

2. Erysipelas: well demarcated

Question 14

What is the difference in systemic effects for cellulitis and erysipelas?

Answer 14

1. Cellulitis: less common

2. Erysipelas: fevers, rigors

Question 15

What is the difference in sepsis for cellulitis and erysipelas?

Answer 15

1. Cellulitis: common

2. Erysipelas: uncommon

Question 16

What is the management of orbital or periorbital cellulitis?

Answer 16

medical emergency and IV Abx as visual impairment

Question 17

What imaging is done in cellulitis?

Answer 17

CT/MRI if oribtial cellulitis

Question 18

What does both cellulitis and erysipelas have?

Answer 18

painful hot swollen and red

Question 19

What is the conservative management?

Answer 19

• Draw around lesion (to see if it grows or shrinks)
• Oral fluids, painkillers
• Monitor observations

Question 20

What is the medical management?

Answer 20

1. Oral ABx (e.g. flucloxacillin)

2. IV ABx (if severe, or near eyes)(e.g. co-amoxiclav)

Question 21

When do you admit a patient?

Answer 21

•	Sepsis
	High HR	
	High RR
	Low BP
•	Confusion
	GCS

Question 22

When is flucloxacillin used?

Answer 22

for staph

Question 23

When is co-amoxiclav used?

Answer 23

for periorbital or orbital cellulitis