Pediatrics
A 6-years-old boy who has been treated since infancy for eczema is coming now to be evaluated for…
A 6-years-old boy who has been treated since infancy for eczema is coming now to be evaluated for honey-colored crusted lesion in antecubital skin area bilaterally. He has no fever but skin infection is suspected. Which of the following is the most likely cause of the skin infection?
Explanation
Core Concept: Patients with atopic dermatitis have a defective epidermal barrier and decreased antimicrobial peptides, making them highly susceptible to secondary bacterial infections, most commonly impetigo caused by Staphylococcus aureus.
Clinical Presentation:
- 'Honey-colored' crusts, weeping, and golden-yellow exudate superimposed on eczematous plaques.
- Complications: Cellulitis, bacteremia, and exacerbation of the underlying eczema.
Diagnosis:
- First-line & Gold Standard: Clinical diagnosis of non-bullous impetigo. Bacterial swab for culture and sensitivity is indicated if the infection is extensive, recurrent, or fails initial empiric therapy (to rule out MRSA).
Management:
- Acute: Topical mupirocin or retapamulin for localized disease.
- Long-term/definitive: Oral antibiotics (e.g., cephalexin, dicloxacillin, or clindamycin/TMP-SMX if MRSA is suspected) for widespread involvement. Optimize underlying eczema control to restore the skin barrier.