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Bullous impetigo (pediatric) in Child
See also in: Anogenital
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Bullous impetigo (pediatric) in Child

See also in: Anogenital
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Contributors: Molly Plovanich MD, Belinda Tan MD, PhD, Amy Swerdlin MD, Gomathy Sethuraman MD, Susan Burgin MD
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Synopsis

This summary discusses pediatric patients. Bullous impetigo in adults is addressed separately.

Bullous impetigo is a localized form of staphylococcal scalded skin syndrome caused by exfoliative toxins (A and B) released by (phage group II) Staphylococcus aureus. These toxins cleave desmoglein 1, resulting in superficial blisters locally at the site of infection. It is primarily seen in children, especially infants, and only rarely occurs in teenagers or young adults. Constitutional symptoms and fever are rare and mild, if they occur. Outbreaks tend to occur during the summer months and in humid climates. The disease commonly affects the diaper region, face, and extremities.

Bullous impetigo lesions initially present as flaccid bullae before rupturing, leaving round erosions that become crusted.

When involvement is more extensive, lesions may even be confused with scald burns. Also, cases have been reported of bullous impetigo affecting the vulvar region, leading to confusion with possible sexual abuse.

Codes

ICD10CM:
L01.03 – Bullous impetigo

SNOMEDCT:
399183005 – Bullous impetigo

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Varicella – Typical polymorphic lesions in various stages: macules, vesicles, pustules, and crusting. Face, trunk, and proximal extremities are involved. Tzanck smear from a vesicle reveals multinucleated giant cells.
  • Tinea cruris, corporis, or pedis (bullous)
  • Stevens-Johnson syndrome – Characteristic target lesions (necrotic center surrounded by erythema and edema [pallor]) along with hemorrhagic crusting of the lips and conjunctiva. There may be associated systemic symptoms.
  • Bullous fixed drug eruption – Well-demarcated, circular or oval, erythematous patches that recur in the same site (usually lips and trunk) each time the offending drug is administered. Lesions characteristically heal with hyperpigmentation.
  • Herpes simplex virus (HSV) infection – Tiny grouped vesicles on an erythematous base that rupture to form polycyclic erosions. Prodromal symptoms are usually present. The skin of the face and hands is commonly affected.
  • Bullous insect bite reactions – Linear irregular streaks of dermatitis with vesiculation at the site of bite, often with a "kissing pattern."
  • Scabies – Pruritic erythematous papules and vesiculopustules on the intertriginous areas, face, genitalia, and palms and soles. Burrows may be present in the finger web spaces, flexor aspect of the wrist, axilla, umbilicus, nipples, buttocks, and penis.
  • Cutaneous candidiasis affects the intertriginous areas, especially the groin or neck, in the form of confluent erythematous patches with multiple small satellite pustules. Potassium hydroxide (KOH) test from a pustular lesion reveals budding spores and pseudohyphae that confirm Candida infection.
  • Chronic bullous dermatosis of childhood – Tense (subepidermal) blisters in the groin, lower abdomen, back, and perioral region. The characteristic rosette-like vesicles resemble a cluster of pearls surrounding a central healing bulla.
  • Contact dermatitis
  • Poison ivy or oak dermatitis
  • Burns (see thermal or electrical burn, burn marks of child abuse)
  • Drug eruption, bullous
  • Bullous pemphigoid
  • Epidermolysis bullosa simplex

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed: 07/28/2017
Last Updated: 06/15/2018
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Bullous impetigo (pediatric) in Child
See also in: Anogenital
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Bullous impetigo (pediatric) : Diaper area, Flaccid bullae, Grouped configuration, Scattered few, Pustules, Vesicles
Clinical image of Bullous impetigo (pediatric)
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