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The child had bullous impetigo, which is usually caused by Staphylococcus aureus.
This is one variant of impetigo, a superficial bacterial infection of the skin. Impetigo is more common in children and is often found around the nose and mouth (as seen in this case). The honey crusts are typical of impetigo. Bullae are less common and should be a tip off that S. aureus is involved.
Given the frequency with which we see cases of community-acquired methicillin-resistant staphylococcal aureus (MRSA), it is probably best to culture all but the most limited cases of impetigo. Community-acquired MRSA can present as bullous impetigo in children or adults. If you suspect MRSA, culture the lesions and start one of the following oral antibiotics: trimethoprim/sulfamethoxazole or clindamycin (tetracycline or doxycycline should be reserved for adults and children older than 12 years of age). Clindamycin has the advantage of covering group A beta-hemolytic Streptococcus pyogenes (GABHS) and most MRSA. Trimethoprim/sulfamethoxazole has excellent MRSA coverage and, like clindamycin, comes in a liquid form for children. Seven to 10 days of antibiotics should be adequate to clear impetigo caused by MRSA.
There is good evidence that topical mupirocin is equally—or more—effective than oral treatment for people with limited impetigo. Mupirocin also covers MRSA. Extensive impetigo not caused by MRSA could be treated for 7 days with antibiotics that cover GABHS and S. aureus such as cephalexin or dicloxacillin. If there are recurrent MRSA infections, one might choose to prescribe intranasal mupirocin ointment and chlorhexidine bathing to decrease MRSA colonization.
The family physician diagnosed bullous impetigo and suspected MRSA. A culture confirmed this 3 days later. Fortunately the physician chose to start the child on oral clindamycin and there was significant improvement by the time the culture came back positive. The physician also discussed hygiene issues with the mother and how to avoid spread within the household.
Photo courtesy of Jack Resneck, Sr, MD. Text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Sauceda AT, Usatine R. Bullous diseases—overview. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:784-789.
To learn more about The Color Atlas of Family Medicine, see:
• http://www.amazon.com/Color-Atlas-Family-Medicine/dp/0071474641
The Color Atlas of Family Medicine is also available as an app for mobile devices. See
The child had bullous impetigo, which is usually caused by Staphylococcus aureus.
This is one variant of impetigo, a superficial bacterial infection of the skin. Impetigo is more common in children and is often found around the nose and mouth (as seen in this case). The honey crusts are typical of impetigo. Bullae are less common and should be a tip off that S. aureus is involved.
Given the frequency with which we see cases of community-acquired methicillin-resistant staphylococcal aureus (MRSA), it is probably best to culture all but the most limited cases of impetigo. Community-acquired MRSA can present as bullous impetigo in children or adults. If you suspect MRSA, culture the lesions and start one of the following oral antibiotics: trimethoprim/sulfamethoxazole or clindamycin (tetracycline or doxycycline should be reserved for adults and children older than 12 years of age). Clindamycin has the advantage of covering group A beta-hemolytic Streptococcus pyogenes (GABHS) and most MRSA. Trimethoprim/sulfamethoxazole has excellent MRSA coverage and, like clindamycin, comes in a liquid form for children. Seven to 10 days of antibiotics should be adequate to clear impetigo caused by MRSA.
There is good evidence that topical mupirocin is equally—or more—effective than oral treatment for people with limited impetigo. Mupirocin also covers MRSA. Extensive impetigo not caused by MRSA could be treated for 7 days with antibiotics that cover GABHS and S. aureus such as cephalexin or dicloxacillin. If there are recurrent MRSA infections, one might choose to prescribe intranasal mupirocin ointment and chlorhexidine bathing to decrease MRSA colonization.
The family physician diagnosed bullous impetigo and suspected MRSA. A culture confirmed this 3 days later. Fortunately the physician chose to start the child on oral clindamycin and there was significant improvement by the time the culture came back positive. The physician also discussed hygiene issues with the mother and how to avoid spread within the household.
Photo courtesy of Jack Resneck, Sr, MD. Text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Sauceda AT, Usatine R. Bullous diseases—overview. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:784-789.
To learn more about The Color Atlas of Family Medicine, see:
• http://www.amazon.com/Color-Atlas-Family-Medicine/dp/0071474641
The Color Atlas of Family Medicine is also available as an app for mobile devices. See
The child had bullous impetigo, which is usually caused by Staphylococcus aureus.
This is one variant of impetigo, a superficial bacterial infection of the skin. Impetigo is more common in children and is often found around the nose and mouth (as seen in this case). The honey crusts are typical of impetigo. Bullae are less common and should be a tip off that S. aureus is involved.
Given the frequency with which we see cases of community-acquired methicillin-resistant staphylococcal aureus (MRSA), it is probably best to culture all but the most limited cases of impetigo. Community-acquired MRSA can present as bullous impetigo in children or adults. If you suspect MRSA, culture the lesions and start one of the following oral antibiotics: trimethoprim/sulfamethoxazole or clindamycin (tetracycline or doxycycline should be reserved for adults and children older than 12 years of age). Clindamycin has the advantage of covering group A beta-hemolytic Streptococcus pyogenes (GABHS) and most MRSA. Trimethoprim/sulfamethoxazole has excellent MRSA coverage and, like clindamycin, comes in a liquid form for children. Seven to 10 days of antibiotics should be adequate to clear impetigo caused by MRSA.
There is good evidence that topical mupirocin is equally—or more—effective than oral treatment for people with limited impetigo. Mupirocin also covers MRSA. Extensive impetigo not caused by MRSA could be treated for 7 days with antibiotics that cover GABHS and S. aureus such as cephalexin or dicloxacillin. If there are recurrent MRSA infections, one might choose to prescribe intranasal mupirocin ointment and chlorhexidine bathing to decrease MRSA colonization.
The family physician diagnosed bullous impetigo and suspected MRSA. A culture confirmed this 3 days later. Fortunately the physician chose to start the child on oral clindamycin and there was significant improvement by the time the culture came back positive. The physician also discussed hygiene issues with the mother and how to avoid spread within the household.
Photo courtesy of Jack Resneck, Sr, MD. Text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Sauceda AT, Usatine R. Bullous diseases—overview. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:784-789.
To learn more about The Color Atlas of Family Medicine, see:
• http://www.amazon.com/Color-Atlas-Family-Medicine/dp/0071474641
The Color Atlas of Family Medicine is also available as an app for mobile devices. See