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Suggest Treatment For Impetigo In A Child

Posted on Thu, 18 Sep 2014

Question: my child 3 yr old has been suffering from impetigo since one month. Dr prescribed bactroban 2% thrice already and antibiotic once. It had improved and almost cured but last week we traveled to Florida and the temperature was very high 100 degrees f (43 degrees Celsius) and after coming back it got bad with full blown and spread throughout his both buttocks. This started a month back with a small pimple or bug bite kind of appearance which he scratched. I have attached the picture taken today. His pediatrician's office prescribed the same ointment again. Shall i visit a dermatologist? any remedies you recommend?

Answered by Dr. Dr. Kakkar (1 hour later)

Brief Answer:
Need more information

Detailed Answer:
Hello and welcome to healthcaremagic

I am Dr. Kakkar. I have gone through your query and I have understood it.

This does'nt look like plain impetigo. Of course, there is secondary/superimposed bacterial infection (Imetiginization) probably secondary to scratching and folliculitis too.

This looks more like Inverse Pityriasis Rosea to me with secondary impetiginization. There can be new crops in P. rosea

I would like to gather more information from you in order to be able to guide you better.

-Is it very itchy?Does he scratch a lot?
-Were the previous episodes localized to the same place? Does it involve other places?

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Kakkar (4 hours later)

Yes it is, specially at night and we are struggling to keep his hands at bay. I make him wear full pajamas so that the access is not easy. so far I have taken him to his pediatrician only and haven't seen any dermatologist yet. It is localized to his two buttocks only. started from his left but was very small. it has become full blown in the last few days. The bigger spots is also oozing light (very less) puss discharge which I can make out looking at his underwear. it's hard for me to cover this area as it's so large as he goes to his daycare. hope this helps.

Answered by Dr. Dr. Kakkar (2 hours later)

Brief Answer:
Oral+topical treatment

Detailed Answer:
Hi.

Thanks for the additional information. Yes it helps a lot.

I would also like to treat him for Scabies,empirically specially since you say that it is very itchy and more so at night. Is anyone else in the family also affected with itching? (There is a usually a positive family history of itching in close contacts)

-A course of an oral antibiotic is warranted to dry up the oozing. I would suggest Syp/susp Amoxycillin 125 mg/ 5ml (5 ml three times a day for 7 days).

-Topically you may apply bactroban 2% ointment at the places which are oozing OR rather you may apply a topical steroid+antibiotic combination ointment (e.g fluticasone propionate+mupirocin ointment) rather than using a plain antibiotic like bactroban ointment ( 2% mupirocin).

-An oral antihistamine e.g Syp cetrizine 5 mg/ 5ml (2.5 ml once or twice daily) would provide him symptomatic relief from itching.

-Once the oozing and pus dries up (within a week) you may treat him for scabies, with a single application of 5% permethrin, applied from neck downwards and kept overnight for 8 hours.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Kakkar (3 minutes later)

Thanks . No one in the family has this nor the itching problem.

Answered by Dr. Dr. Kakkar (5 minutes later)

Brief Answer:
Oral+topical treatment

Detailed Answer:
Hi

Still I would like to treat him empirically for scabies after a week, once the infection dries up.

Regards

Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar