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• W3157221423 abstract "An 11-year-old boy with a history of atopic dermatitis developed a progressive, pruritic rash on his face and extremities over 2 weeks. Bullous and superficially eroded crusted red plaques were located throughout the bilateral upper and lower extremities (Figure). He was empirically treated with cefadroxil 500 mg twice daily for 1 week along with topical mupirocin ointment. Bacterial culture showed heavy growth of methicillin-sensitive Staphylococcus aureus, confirming the diagnosis of bullous impetigo. Polymerase chain reaction test of facial erosions was negative for herpes simplex virus. At 2-week follow-up, examination revealed only postinflammatory erythema and hypopigmentation. Bullous impetigo is caused by Staphylococcus aureus exfoliative toxins targeting epidermal desmoglein 1, resulting in separation of the skin within the superficial epidermis.1Stanley J.R. Amagai M. Pemphigus, bullous impetigo, and the staphylococcal scalded-skin syndrome.N Engl J Med. 2006; 355: 1800-1810Crossref PubMed Scopus (337) Google Scholar,2Mannschreck D. Feig J. Selph J. Cohen B. Disseminated bullous impetigo and atopic dermatitis: Case series and literature review.Pediatr Dermatol. 2020; 37: 103-108Crossref PubMed Scopus (5) Google Scholar This presents clinically as small clusters of yellow, fluid-filled vesicles that become 1- to 2-cm flaccid bullae. Later lesions present as large, eroded plaques with a yellow-brown crust and a collarette of scale.2Mannschreck D. Feig J. Selph J. Cohen B. Disseminated bullous impetigo and atopic dermatitis: Case series and literature review.Pediatr Dermatol. 2020; 37: 103-108Crossref PubMed Scopus (5) Google Scholar, 3Sommer L.L. Reboli A.C. Heymann W.R. Bacterial diseases.in: Bolognia J.L. Schaffer J.V. Cerroni L. Dermatology. 4th ed. Elsevier, Philadelphia, PA2017Google Scholar, 4Hartman-Adams H. Banvard C. Juckett G. Impetigo: diagnosis and treatment.Am Fam Phys. 2014; 90: 229-235PubMed Google Scholar The disease is seen most commonly in infants but occurs in older children as well.3Sommer L.L. Reboli A.C. Heymann W.R. Bacterial diseases.in: Bolognia J.L. Schaffer J.V. Cerroni L. Dermatology. 4th ed. Elsevier, Philadelphia, PA2017Google Scholar A defective skin barrier, because of trauma or a skin condition such as eczema, places patients at risk for bullous impetigo.4Hartman-Adams H. Banvard C. Juckett G. Impetigo: diagnosis and treatment.Am Fam Phys. 2014; 90: 229-235PubMed Google Scholar Diagnosis of bullous impetigo is typically made clinically, but culture may be indicated to differentiate from other blistering conditions as well as determine antimicrobial sensitivity.2Mannschreck D. Feig J. Selph J. Cohen B. Disseminated bullous impetigo and atopic dermatitis: Case series and literature review.Pediatr Dermatol. 2020; 37: 103-108Crossref PubMed Scopus (5) Google Scholar,4Hartman-Adams H. Banvard C. Juckett G. Impetigo: diagnosis and treatment.Am Fam Phys. 2014; 90: 229-235PubMed Google Scholar Infectious etiologies including varicella, candidiasis, and eczema herpeticum (eczema with superimposed herpes simplex virus), bullous arthropod bite reaction, and acute allergic contact dermatitis can be confused with bullous impetigo.2Mannschreck D. Feig J. Selph J. Cohen B. Disseminated bullous impetigo and atopic dermatitis: Case series and literature review.Pediatr Dermatol. 2020; 37: 103-108Crossref PubMed Scopus (5) Google Scholar,3Sommer L.L. Reboli A.C. Heymann W.R. Bacterial diseases.in: Bolognia J.L. Schaffer J.V. Cerroni L. Dermatology. 4th ed. Elsevier, Philadelphia, PA2017Google Scholar These entities can be differentiated either through history, close clinical examination, or microbial studies. Oral antibiotic treatment is recommended for widespread disease to shorten the disease course, prevent spread to close contacts, and reduce risk for complications.3Sommer L.L. Reboli A.C. Heymann W.R. Bacterial diseases.in: Bolognia J.L. Schaffer J.V. Cerroni L. Dermatology. 4th ed. Elsevier, Philadelphia, PA2017Google Scholar,4Hartman-Adams H. Banvard C. Juckett G. Impetigo: diagnosis and treatment.Am Fam Phys. 2014; 90: 229-235PubMed Google Scholar Staphylococcal scalded skin syndrome is a potential complication in infants and young children or adults with renal dysfunction who cannot clear the exfoliative toxin.3Sommer L.L. Reboli A.C. Heymann W.R. Bacterial diseases.in: Bolognia J.L. Schaffer J.V. Cerroni L. Dermatology. 4th ed. Elsevier, Philadelphia, PA2017Google Scholar As the majority of bullous impetigo is caused by methicillin-sensitive S aureus, a 7-day course of topical mupirocin or retapamulin or first generation oral cephalosporins are effective in management. Patients with methicillin-resistant S aureus require treatment with trimethoprim-sulfamethoxazole, clindamycin, or tetracyclines.4Hartman-Adams H. Banvard C. Juckett G. Impetigo: diagnosis and treatment.Am Fam Phys. 2014; 90: 229-235PubMed Google Scholar,5Stevens D.L. BIsno A.L. Chambers H.F. Dellinger E.P. Goldstein E.J.C. Gorbach S.L. et al.Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America.Clin Infect Dis. 2014; 59: e10-e52Crossref PubMed Scopus (871) Google Scholar" @default.
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• W3157221423 title "Blistering Rash in an Adolescent" @default.
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