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You are seeing a 13 month old with a rash for 3 days. It started as fluid-filled vesicles that grew, burst, and released clear-yellow non-purulent fluid. It seems mildly itchy to the parent. The child has had a low-grade fever to 38.2 for one day and appears otherwise well. There is no past medical history and no ill contacts; immunizations are up to date.
Open access, Pereira LB – Anais brasileiros de dermatologia (2014 Mar-Apr)
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October 20, 2020 at 10:46 am
D) Oral TMP-SMX
The photo and history are most consistent with bullous impetigo. 90% of cases occur in children < 2 years old. Bullous impetigo is almost exclusively caused by S. aureus, whereas nonbullous impetigo may be caused by group A streptococcus. In bullous impetigo flaccid bullae form as a result of exfoliative toxin from S. aureus. Systemic symptoms such as fever are more common than in non-bullous impetigo. While localized nonbullous impetigo can be treated with topical mupirocin, bullous impetigo should be treated with oral anti-staphylococcal antibiotics. In a well-appearing nontoxic child, IV antibiotics are not necessary.