The VisualDx Image Collection Helps Resident Narrow his diagnosis

Anik D., a resident at Maimonides, shares how he was helped by the VisualDx image library in making his diagnosis:

A 45-year-old male of African descent who is immunocompromised presented with crusted yellow blisters and some erosions. VisualDx’s photos help me narrow my diagnosis to bullous impetigo. It was very helpful to see the photos and glance at the therapy options to confirm my plan.

What is bullous impetigo?

Bullous impetigo is a superficial infection of skin typically caused by phage group II staphylococci and, less often, by other staphylococci phages. Additionally, there have been a few reports of beta-hemolytic streptococci causing bullous impetigo. It is primarily seen in children and does not commonly occur in teenagers or young adults. It presents as a painful, red rash with fragile bullae and honey-colored crusting. Constitutional symptoms such as fever are rare and mild, if they occur. Outbreaks tend to occur during the summer months and in humid climates.

What should we be aware of when making a diagnosis?

Given the prevalence of MRSA, maintain a high index of suspicion for this diagnosis and make the initial choice of empiric antibiotic therapy accordingly. The rate of CA-MRSA in impetigo has been reported to range from 1%-10%, depending on the study population. Therefore, it is helpful to be aware of patterns of antimicrobial resistance within your community.

How can we treat this?

For limited disease, topical mupirocin or retapamulin ointment may be used.

For systemic or widespread infections, systemic antibiotics may be used. Dicloxacillin or cephalexin is recommended, as S aureus isolates from impetigo are usually methicillin susceptible.

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