Diagnose It: Itchy Lesions

NEWS/ QUIZ

2 MIN QUIZ

A 16-year-old boy presents with pimple-like lesions around his mouth and a cluster of small pustules on his right forearm that have started to blister from constant scratching. The patient reports intense itching of the pustules that has lasted for several days, along with inflammation and erythema of the affected areas. He has no fever or fatigue and describes pain at the lesion sites. Additionally, he has no history of acne, practices good hygiene, and keeps a healthy diet. He is an athlete and participates in contact sports at school, including football and wrestling. His mother accompanies him to his appointment, worried that his condition may be Monkeypox.

What is the diagnosis?

Select the correct answer

A) Acne

B) Insect bites

C) Impetigo

D) Monkeypox

CORRECT

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INCORRECT

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Answer is: C

Impetigo is a common bacterial skin infection that can produce blisters and sores anywhere on the body.^1,2 It is classified into 2 types: nonbullous (70% of cases) and bullous (30% of cases).^1,2

This patient most likely has nonbullous impetigo, the primary type, caused by the proliferation of 2 types of bacteria on the skin, Staphylococcus aureus or Streptococcus pyogenes (group A strep), either alone or in combination.^1-3 Although the highest prevalence of this type of impetigo is among 2- to 5-year-olds, the likely cause of infection in this teenage athlete was skin-to-skin contact during wrestling practice or a meet that spread through self-inoculation.^1,4 Impetigo is highly contagious and can spread rapidly to form satellite lesions after initial infection.⁴Nonbullous impetigo does not cause a fever; however, the small vesicles and pustules with erythematous bases can cause blisters that rupture on their own or open from scratching.⁴It is important to inform the patient about the increased risks of community-associated methicillin-resistant Staphylococcus aureus (MRSA) infections caused by the growing problem of bacterial resistance. Playing contact sports is a risk factor for MRSA skin infections that can cause impetigo.^4,5 Nevertheless, most healthy patients practicing good skin care and hygiene respond to standard treatments for nonbullous impetigo. However, they may need additional microbiological testing to determine the specific strain of bacteria causing the infection. Then, the doctor can select the appropriate systemic treatments to ensure the condition resolves without further complications.^4,6

References

Hartman-Adams H, Banvard C, Juckett G. Impetigo: diagnosis and treatment. Am Fam Physician. 2014;90(4):229-235. https://www.aafp.org/pubs/afp/issues/2014/0815/p229.html
Centers for Disease Control and Prevention. Impetigo: all you need to know. Published June 27, 2022. Accessed August 16, 2022. https://www.cdc.gov/groupastrep/diseases-public/impetigo.html
US Food and Drug Administration. How to treat impetigo and control this common skin infection. Updated November 1, 2016. Accessed August 16, 2022. https://www.fda.gov/consumers/consumer-updates/how-treat-impetigo-and-control-common-skin-infection
Nardi NM, Schaefer TJ. Impetigo. StatPearls Publishing; 2021. Accessed August 16, 2022. https://www.ncbi.nlm.nih.gov/books/NBK430974/
Kosar L, Laubscher T. Management of impetigo and cellulitis: simple considerations for promoting appropriate antibiotic use in skin infections. Can Fam Physician. 2017;63(8):615-618.
NICE. Impetigo: antimicrobial prescribing. Published February 26, 2020. Accessed August 16, 2022. https://www.guidelines.co.uk/skin-and-wound-care/nice-impetigo-guideline/455223.article

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