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Home » Features » Derm DX


DERMDX: ITCHY BLISTERS ON SHINS

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FIGURE 2. BLISTERS HAVE POPPED, LEAVING CRUSTY LESIONS.




FIGURE 1. EARLY BLISTERING STAGE.



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FIGURE 2. BLISTERS HAVE POPPED, LEAVING CRUSTY LESIONS.




FIGURE 1. EARLY BLISTERING STAGE.



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FIGURE 2. BLISTERS HAVE POPPED, LEAVING CRUSTY LESIONS.



 * CASE STUDY:

 * EXPLANATION:

A 15-year-old adolescent presents to the clinic for evaluation and treatment of
scattered blisters on both legs. The condition was first noted 5 days ago. The
patient notes that the blisters were preceded by slight itching. He states that
3 of the blisters have “popped” and drained fluid. These sites continue to itch
on occasion. The patient plays football but is unaware of any other players with
similar lesions. The patient denies fever, fatigue, and swollen glands. Physical
examination reveals 2 intact tense bullae (Figure 1) and 2 erythematous patches
with scale (Figure 2).

Impetigo is among the most common skin conditions in children aged 2 to 5 years
but may occur at any age.1 The condition is caused by infection with
Streptococcus pyogenes or Staphylococcus aureus, is highly contagious, and
predominately affects the...

Submit your diagnosis to see full explanation.

Impetigo is among the most common skin conditions in children aged 2 to 5 years
but may occur at any age.1 The condition is caused by infection with
Streptococcus pyogenes or Staphylococcus aureus, is highly contagious, and
predominately affects the lower legs and face. Cuts and abrasions are common
bacterial entrance points and contact sports such as football and rugby
predispose athletes to transmission.2 Impetigo is most prevalent in tropical,
resource-poor countries with more than 162 million children affected at any one
time worldwide.3

Impetigo is classified as either bullous or nonbullous, with the latter
representing 30% of all cases.1 Nonbullous impetigo begins as an erythematous
macule that rapidly vesiculates and ruptures. The serous fluid dries leaving a
honey-combed, crusted exudate. Rubbing and scratching can lead to rapid spread
of lesions. Bullous impetigo presents with superficial, fragile bullae of
varying size. Onset is rapid; spontaneous drainage of the lesions leaves a
collarette of scale and crusts.

The diagnosis of impetigo is usually made clinically. Culture may be prudent to
rule out methicillin-resistant S aureus (MRSA). Lesions should be lightly
cleansed to remove superficial crusting. When not extensive, individual lesions
may respond to treatment with topical mupirocin.4 A course of an oral antibiotic
that covers both S aureus and S pyogenes is often instituted to decrease the
duration and extent of disease.5

Brittany Spinosa-Weber, PA-C, is a physician assistant at the DermDox
Dermatology Centers in Leola, Pennsylvania. Stephen Schleicher, MD, is director
of the DermDox Dermatology Centers in Pennsylvania, associate professor of
medicine at Commonwealth Medical College, and clinical instructor of dermatology
at Arcadia University and Kings College.

REFERENCES

1. Hartman-Adams H, Banvard C, Juckett G. Impetigo: diagnosis and treatment. Am
Fam Physician. 2014;90(4):229-235.

2. Ludlam H, Cookson B. Scrum kidney: epidemic pyoderma caused by a
nephritogenic Streptococcus pyogenes in a rugby team. Lancet.
1986;2(8502):331-333. doi:10.1016/s0140-6736(86)90015-2

3. Bowen AC, Mahé A, Hay RJ, et al. The global epidemiology of impetigo: a
systematic review of the population prevalence of impetigo and pyoderma. PLoS
One. 2015;10(8):e0136789. doi:10.1371/journal.pone.0136789

4. Koning S, van der Sande R, Verhagen AP, et al. Interventions for impetigo.
Cochrane Database Syst Rev. 2012;1(1):CD003261.
doi:10.1002/14651858.CD003261.pub3

5. Nardi NM, Schaefer TJ. Impetigo. In: StatPearls. StatPearls Publishing; 2021
Jan.  Updated 2021 Aug 11. Accessed September 17, 2021.

QUESTION

What is the most likely diagnosis?
 * Bullous pemphigoid
 * Poison ivy
 * Poison sumac
 * Bullous impetigo

1/1
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Please mark all the Question(s) to submit your Quiz.


TOPICS:

Case Studies Dermatology DermDx Impetigo Infectious Disease
Methicillin-Resistant Staphylococcus Aureus


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