5 year Old Child Presents With Blistering Around The Mouth

A 5 year old child is brought to his pediatrician by his mother with a 2 day history of blistering around the mouth. The mother says that she noticed a single tiny blister near his lips 2 days ago , but now there are multiple small blisters around his mouth and nostrils. Several of the blisters have broken and have become crusted. She has not noticed any other lesions else where on the body. She says that he has never has these lesions previously. The child has been complaining of his mouth hurting and itching and has been rubbing his lips. There are no symptoms of congestion, ear or throat pain or cough. The child has not consumed any new food recently or used any new personal hygiene products. Mother mentions that the child is is kinder garden , and one of the student also has suffered from similar findings.
The Photo of the child's lesions is shown below:

 What Is The Diagnosis?

.
.
Impetigo

Case Discussion:
Impetigo is a highly contagious skin infection caused by Staphylococcus aureus or Group A Streptococci. It is most commonly seen in infants and school age children.


Clinical features:
Patients present with a history of:

• Facial pruritis and pain
• Absence of symptoms related to pharyngitis or otitis media

On physical examination following findings are noticed:

• Erythematous vesicles or pustules around the mucosal surfaces of the mouth and nostrils.
• 'These vesicles or pustules eventually break and become yellow crusted.
• The crusts are often described as honey colored crusts. 

Diagnosis:

The condition is usually diagnosed by the appearance and the history and lab tests are at most times not needed. Sometimes if the sores does not clear even after antibiotic treatment then the sample of the fluid from the sore can be tested to identify the organism and antibiotic sensitivity. 

Treatment:

1. Topical antibiotic may be used for limited cases with only a few pustules.

2. Oral antibiotics are indicated for more extensive lesions.

3. Lesions should be washed with a antimicrobial soap or solution until completely resolved.

4. The child should be kept away fro school or day care to prevent spreading of infection and the contagious period is usually 24 to 48 hours after the antibiotic treatment is started. 

% Even without treatment impetiogo resolves on its own in 2 to 3 weeks but antibiotics should be given to reduce the duration of disease and risk of spreading the infection.