Bullous Impetigo on Hand of a 45-Year-Old Man

The left hand of a 45-year-old man was affected with the characteristic intact bullae and dried, crusted, ruptured bullae of bullous impetigo.

Bullous impetigo is caused by an epidermolytic staphylococcal exotoxin produced at the site of infection. This toxin causes intradermal cleavage below or in the stratum granulosum.

Robert P. Blereau, MD of Morgan City, La, comments that infants and children are more commonly affected than older persons. Most outbreaks occur on the face. Secondary infections, such as osteomyelitis, pneumonia, and septic arthritis, may develop in infants with untreated bullous impetigo.

In this patient, bullous impetigo cleared completely after a 10-day course of cephalexin, 500 mg tid, and mupirocin ointment applied 3 times daily.