How would you diagnose this boy’s rapidly spreading tender eruption on his face and trunk?

A 10-year-old male presented for a rapidly spreading tender and itchy eruption on his face and trunk of 3 to 4 days duration. He is otherwise healthy.

How would you diagnose this eruption?

A. Cellulitis
B. Folliculitis, bacterial 
C. Folliculitis, Candida
D. Bullous impetigo
E. Contact dermatitis

(Answer and discussion on next page)

Answer: Bullous impetigo

Bullous impetigo is typically due to a staphylococcal infection. Bullous impetigo usually consists of small or large, superficial, fragile bullae. The lesions spread locally in the face, trunk, extremities, buttocks, or perineal regions through direct autoinoculation.

This infection responds rapidly to appropriate antibiotic therapy; it is recommended to treat for the staphylococcal nasal carrier to prevent recurrence.