|HOW I MANAGE
|Year : 2012 | Volume
| Issue : 1 | Page : 53-54
Recurrent pyoderma in children
Ramesh M Bhat
Department of Dermatology, Father Muller Medical College, Mangalore, Karnataka, India
|Date of Web Publication||23-Oct-2012|
Ramesh M Bhat
Professor and HOD, Department of Dermatology, Fr. Muller Medical College Hospital, Kankanady, Mangalore- 5750 02
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Bhat RM. Recurrent pyoderma in children. Indian J Paediatr Dermatol 2012;13:53-4
| Introduction|| |
Pyodermas in children constitute one of the most common cutaneous diseases. In one of our studies on pyoderma, children constituted nearly 40% of the disease population. Recurrent pyodermas pose a challenge in the treatment. The difficulty in treating these cases may be due to two factors:
Impetigo (bullous and non-bullous), superficial folliculitis and ecthyma are the three important patterns of primary pyodermas seen by us. Eczema with secondary infection (including atopic dermatitis), scabies, papular urticaria with secondary infection are the common secondary pyodermas. We have also noted that Staphylococcus aureus is the single most common organism isolated in these cases. It is the causative bacteria in bullous impetigo and the most common isolated organism in other varieties of pyodermas. β-hemolytic streptococci, either alone or sometimes in combination with staphylococci, can be isolated in a few cases of non-bullous impetigo.
- Increased antimicrobial resistance
- Changing pattern of microbiology of pyoderma, including community-acquired methicillin-resistant Staphylococcus aureus (MRSA)
| How I Manage|| |
In cases of recurrent pyodermas in children, I take the following factors into consideration:
Usually recurrent primary pyoderma are common in school children where as recurrent secondary pyodermas may be seen in association with atopic dermatitis and papular urticaria in preschool children. Personal hygiene is one of the important factors specially in children. Family history of atopy and other members in the family specially other children suffering from pyodermas is also important. Past treatment history of both topical and systemic antibitocs is also required. I consider improper choice of antibiotic and inadequate dosage and duration of the treatment are important factors in the recurrent pyodermas.
- Age of the child
- Personal hygiene
- Family history and history of atopy
- Past treatment history
I advise for culture and sensitivity of the pus in cases of recurrent pyodermas. We have observed that staphylococcus aureus is the most important organism in these cases. I advocate following measures in these cases.
- Cleaning of the lesions with either saline or soap and water. Due importance is given for daily bath and dressing patterns. As humidity is an important factor, wearing loose cotton clothes is advised. I usually don't advise potassium permanganate soaks as sometimes irritation is observed because of overuse.
- Topical agents : I prefer mupirocin or Fusidic acid for application as both these agents are helpful in staphylococcal infection.
- Oral drugs: I prefer oral cephalosporins, azithromycin or amoxicillin with cloxacillin as the first line of treatment in recurrent pyodermas. I prefer to give an adequate dosage of these drugs for a duration of 10-15 days
- Nutritional status: As pyodermas are more common in malnourished children, proper advise is given if the child is suffering from malnutrition. I also advise a consultation with a pediatrician in case of any suspicion of systemic disease
- Nasal carriage of organisms: Carrier state is also an important factor in recurrent staphylococcal pyodermas. I advise application of mupirocin cream to the nasal vestibule, armpits, umbilicus and perianal and periurethral areas in these cases
- MRSA-induced recurrent pyodermas: MRSA has emerged as an important cause of multiantibiotic resistant and recurrent pyodermas. We have observed that community-acquired MRSA may be a cause of pyodermas in children. Even in these children, cephalosporins are effective, unlike hospital-acquired MRSA, which may require antibiotics like vancomycin and Linezolid
- Treatment of other conditions: If recurrent pyodermas are seen, especially in children with atopic dermatitis or papular urticaria, management of primary condition is also important.
| Conclusion|| |
In cases of recurrent pyodermas, I prefer to perform culture and sensitivity tests and treat accordingly with an adequate dosage and duration of an appropriate antibiotic. Topically, mupirocin and fusidic acid are preferred. Personal hygiene and carrier state for Staphylococcus aureus have to be managed accordingly. In cases of recurrent secondary pyoderma, proper management of the primary dermatological condition is ensured.