A 2-year-old boy presented with a lesion of 2 weeks’ duration on his face. The lesion initially had presented as small patch of what his parents had assumed was ringworm; however, the rash did not respond to an over-the-counter antifungal medication administered by the parents.
The lesion continued to enlarge and became mildly pruritic. The child’s past medical history is remarkable for atopic dermatitis.
Based on his clinical presentation and history, the boy received a diagnosis of impetiginized eczema.
Patients with atopic dermatitis are predisposed to infection with Staphylococcus aureus, which worsens their skin disease. It has been postulated that a lack of antimicrobial peptides such as defensins is partly responsible for this susceptibility. Our patient’s eczema responded well to topical corticosteroids and oral cephalexin; nevertheless, it has been proposed that the application of topical corticosteroids alone, without the administration of systemic oral antibiotics, may be sufficient for significant improvement of impetiginized atopic dermatitis in children.1
1. Travers JB, Kozman A, Yao Y, et al. Treatment outcomes of secondarily impetiginized pediatric atopic dermatitis lesions and the role of oral antibiotics. Pediatr Dermatol. 2012;29(3):289-296.
The author thanks Amy Theos, MD, at the University of Alabama at Birmingham Department of Dermatology, for her input on this article.