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This 12-year-old boy had been treated for 7 days for poison ivy (blisters on the hands) prior to presentation in my clinic.  He reports that the blisters were mild-to-moderately painful, weeping, with very little to no pruritus.  Strong topical steroids did not help the condition at all.  What is your diagnosis? 

Methicillin-Resistant Staphylococcus Aureus (MRSA) Bullous Impetigo.
Methicillin-Resistant Staphylococcus Before
Methicillin-Resistant Staphylococcus After

I am seeing more and more community acquired MRSA in our dermatology clinic. In children, impetigo (the majority of cases are caused by Staphylococcus Aureus although some are caused by streptococcus) can quite often cause a puzzling blistering rash.

In his particular case, we performed a culture, and the results indicated that the MRSA was sensitive to sulfa antibiotics. He was treated with a two-week course of Bactrim double strength with excellent results, as shown in the picture taken at the two week follow-up.

The pearl here is any time you see children or adolescents with a blistering reaction, always keep in mind the bullous variant of impetigo (bullous impetigo).

Additional pictures of Bullous Impetigo
Methicillin-Resistant Staphylococcus
Methicillin-Resistant Staphylococcus

CME article on Imetigo

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