Parents will usually bring their children in because they
are developing unsightly skin lesions, which may be pruritic
and are found most often on the face or other exposed areas.
Streptococcal lesions consist of irregular or somewhat
circular, red, oozing erosions, often covered with a yellow-
brown crust. These may be surrounded by smaller erythematous
macular or vesiculopustular areas. Staphylococcal lesions
present as bullae which are quickly replaced by a thin shiny
crust over an erythematous base.
What to do:
Prescribe mupiricin 2% ointment (Bactroban) to the rash
tid for 3-5 days. Have parents soften and cleanse crusts
with warm soapy compresses before applying the antibiotic
ointment.
For severe or resistant cases, add a 10 day course of
erythromycin or penicillin VK (250mg qid), or one
intramuscular injection of benzathine penicillin (600,000
units im for children 6 years and younger, 1.2 million
units im for children over 7 years.) For suspected
staphylococcal infections use dicloxacillin (250mg qid) in
place of penicillin (or prescribe erythromycin or
cefadroxil).
What not to do:
Do not routinely culture these lesions. This is only
indicated for unusual lesions or lesions that fail to
respond to routine therapy.
Discussion
Impetigo is usually self-limiting and it is believed that
antibiotic treatment does not alter the subsequent incidence
of secondary glomerulonephritis. Impetigo is very contagious
among infants and young children and may be associated with
poor hygiene or predisposing skin eruptions such as chicken
pox, scabies, and atopic and contact dermatitis.
