Question: Rash

B) Oral cephalexin
The patient has the classic honey-crusted lesions of impetigo, which is commonly seen around the nose and mouth. Other types of impetigo include bullous impetigo and ecthyma (punched out ulcers with a yellow crust). The most common cause of impetigo is Staph aureus, usually methicillin-sensitive. Strep pyogenes is another common cause of impetigo. Bullous impetigo is always Staph aureus, and ecthyma is always Strep pyogenes. Oral cephalexin covers both these organisms. If there is some reason MRSA is highly suspected (previous MRSA, family members with MRSA), then add trimethoprim-sulfamethoxazole to cephalexin, or give clindamycin. If there are few lesions, topical mupirocin (brand name bactroban) can be used, but topical bacitracin is not helpful. Oral trimethoprim-sulfamethoxazole may have inadequate coverage of Strep pyogenes. Oral doxycycline is contraindicated in < 8 year olds due to potential staining of teeth in young children (although it is used if the disease is serious and there are not alternative medications).