Disseminated Bullous Impetigo in Children with Atopic Dermatitis

Disseminated Bullous Impetigo in Children with Atopic Dermatitis

• Impetigo is the most common bacterial infection in children, with 30% of cases being bullous impetigo caused by exfoliative toxins A, B, and D from Staphylococcus aureus.
• Atopic dermatitis (AD) is a common pediatric dermatologic disorder that increases the risk of bacterial and viral cutaneous infections, including S. aureus and S. pyogenes.
• AD is also linked to increased risk of extracutaneous infections, including streptococcal pharyngitis, viral upper respiratory infection, influenza, pneumonia, sinus infections, varicella, and urinary tract infections.
• The immune response in AD patients is dysregulated and biased toward type 2 responses, leading to an increased risk of infections.
• Disseminated bullous impetigo (DBI) in children with AD is rare, with only one case report published, and no reports of DBI in AD causing dissemination.
• A study describes 12 children diagnosed with DBI, eleven of which occurred in the context of severe AD, within a six-month period by the Johns Hopkins Pediatric Dermatology Division.
• Misdiagnosis of DBI is common, with the most frequent being a flare of AD, and other misdiagnoses including scabies, eczema herpeticum, ecthyma, varicella, and eczema coxsackium.
• DBI overlying chronic AD can be difficult to diagnose, as true bullae may not be visible.
• Viral cultures are not indicated for DBI unless clinical findings are consistent with eczema herpeticum or eczema coxsackium.
• Rapid clearing of lesions with antibiotic treatment confirms the diagnosis of DBI.
• MSSA is likely the cause of the majority of DBI cases, and clindamycin resistance is more common than methicillin resistance among DBI cases.
• Antibiotic coverage for MRSA (clindamycin or TMP/SMX) to treat uncomplicated cases of DBI is likely unnecessary, particularly in the mid-Atlantic region of the United States.

Test your knowledge on Disseminated Bullous Impetigo in Children with Atopic Dermatitis with our quiz! Learn about the common bacterial infection in children and the risks associated with atopic dermatitis. Explore the immune response in AD patients and the rare occurrence of disseminated bullous impetigo in children with AD. Challenge yourself to identify the misdiagnoses of DBI and understand the diagnostic procedures and treatment options for this condition. Take the quiz now and enhance your understanding of DBI