What caused this spreading pustular rash?

November 5, 2009

For 1 week, a 28-year-old man has had this tender, spreading rash on his chin. He is otherwise healthy. What does this look like to you?

Case:
For 1 week, a 28-year-old man has had this tender, spreading rash on his chin. He is otherwise healthy. What does this look like to you?

A. Streptococcal impetigo.
B. Staphylococcal impetigo.
C.Candida folliculitis.
D. Acne.
E. Rosacea.
F. Contact dermatitis.

Answer on Next Page

Answer: Impetigo

This patient had staphylococcal impetigo, B, that was spread by shaving. He was treated with intranasal mupirocin for the presumed nasal carrier state and was also given an oral antibiotic to cover for methicillin-resistant Staphylococcus aureus. The rash resolved uneventfully.

Candida infection could resemble this patient’s rash, although it would be unusual in an otherwise healthy person. Neither acne nor rosacea would be expected to present in this manner over a 1-week period. Contact dermatitis is not typically pustular and is usually pruritic.

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