CASE HISTORY
Leili,a three-year-old girl,was brought to the pediatrician by her mother,who was worried about the rash on Leili's lip.It started four days earlier as a little bump above her lip that spread to the corner of her mouth.The base of the rash was red and covered by pustules.The little girl said that her rash hurt,and the clinician noticed a honey-colored crust on the ruptured pustules.Leili's mother said that her daughter had not been trying to scratch the rash,nor was the area around it hot to the touch.Leili's mother was told that her little girl had impetigo,a skin infection often caused by bacteria called staphylococci,although streptococci can also cause it.The doctor gently swabbed a sample from one of Leili's sores and sent it to the lab,where the causative agent would be identified and its antibiotic susceptibility determined.She explained that impetigo is a very contagious disease,and she gave Leili's mother a topical antibiotic to use.Treating topically rather than orally would accomplish two goals.Topical application would reduce the chance that the bacteria would develop drug resistance,and because Leili had a very mild case of impetigo,the antibiotic in the gel should easily penetrate the pustules and kill the organism.Leili and her mother left but returned in a week for a follow-up exam.The "rash" was gone,replaced by Leili's smile.The pediatrician explained that the cause was in fact methicillin-sensitive Staphylococcus aureus (MSSA),not MRSA.Leili's mother in turn reported that another child at Leili's day care had impetigo before Leili,and that is where Leili probably acquired the infection.
Leili was suffering from nonbullous impetigo;however,a bullous form also exists.How would you distinguish the two and how would you approach the creation of a treatment plan for this disease?

Question

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The Answer of CASE HISTORY
Leili,a three-year-old girl,was brought to the pediatrician by her mother,who was worried about the rash on Leili's lip.It started four days earlier as a little bump above her lip that spread to the corner of her mouth.The base of the rash was red and covered by pustules.The little girl said that her rash hurt,and the clinician noticed a honey-colored crust on the ruptured pustules.Leili's mother said that her daughter had not been trying to scratch the rash,nor was the area around it hot to the touch.Leili's mother was told that her little girl had impetigo,a skin infection often caused by bacteria called staphylococci,although streptococci can also cause it.The doctor gently swabbed a sample from one of Leili's sores and sent it to the lab,where the causative agent would be identified and its antibiotic susceptibility determined.She explained that impetigo is a very contagious disease,and she gave Leili's mother a topical antibiotic to use.Treating topically rather than orally would accomplish two goals.Topical application would reduce the chance that the bacteria would develop drug resistance,and because Leili had a very mild case of impetigo,the antibiotic in the gel should easily penetrate the pustules and kill the organism.Leili and her mother left but returned in a week for a follow-up exam.The "rash" was gone,replaced by Leili's smile.The pediatrician explained that the cause was in fact methicillin-sensitive Staphylococcus aureus (MSSA),not MRSA.Leili's mother in turn reported that another child at Leili's day care had impetigo before Leili,and that is where Leili probably acquired the infection.
Leili was suffering from nonbullous impetigo;however,a bullous form also exists.How would you distinguish the two and how would you approach the creation of a treatment plan for this disease?