Cellulitis — SCE Dermatology MCQ

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EasyCutaneous InfectionCellulitisSCE Dermatology

A 30-year-old woman presents with a painful, indurated, erythematous plaque on her right shin. It is warm and tender. She developed symptoms after sustaining a minor scratch 3 days ago. She is systemically well with temperature 37.8°C. Bilateral pedal pulses are present. What is the most likely diagnosis?

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Correct answer: E — Cellulitis

The correct answer is E, cellulitis. This woman has a unilateral, warm, tender, indurated, erythematous plaque on the shin arising three days after a minor skin breach, which is the classic portal of entry for cellulitis (usually streptococcal or staphylococcal). Low grade fever (37.8C) with preserved systemic wellbeing and intact pedal pulses fits an Eron Class I presentation, meaning no signs of systemic toxicity or uncontrolled comorbidity, appropriate for outpatient oral antibiotics such as flucloxacillin. NICE NG141 identifies the combination of a breach in the skin barrier, spreading warm erythema, and tenderness as the key diagnostic features of cellulitis, distinguishing it from its mimics. The acute onset following trauma, rather than a chronic or bilateral pattern, is the discriminating clue that separates this from the other options listed.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/skin-conditions