Tom, 10 years old, Bullous eruption

It was bullous impetigo.

Let’s rule out differential diagnoses:

• Pemphigus:

This is a rare condition but it can affect children; the bullae are fragile and the skin is not erythematous; most often, only post-bullous erosions are seen. The presence of mucosal involvement will aid the diagnosis. The appearance can be misleading and the outcome will not be favourable following antibiotic therapy, which will require a skin biopsy.

• Lyell’s syndrome:

The symptoms are intense. There is deterioration of the overall condition and the child is exhausted. Semiologically, there is “wet laundry” detachment with Nikolsky’s sign on intact skin and mucosal involvement. This is a dermatological emergency that requires immediate hospitalisation.

• VZV infection:

Shingles in children is uncommon. The primary lesion is a vesicle that develops into clusters on inflammatory skin. The pattern is metameric. Pain and burning are the primary symptoms. A swab sample can be taken for an HSV PCR test if there is any doubt about the diagnosis.

It is indeed bullous impetigo.

Let’s rule out differential diagnoses:

• Pemphigus:

This is a rare condition but it can affect children; the bullae are fragile and the skin is not erythematous; most often, only post-bullous erosions are seen. The presence of mucosal involvement will aid the diagnosis. The appearance can be misleading and the outcome will not be favourable following antibiotic therapy, which will require a skin biopsy.

• Lyell’s syndrome:

The symptoms are intense. There is deterioration of the overall condition and the child is exhausted. Semiologically, there is “wet laundry” detachment with Nikolsky’s sign on intact skin and mucosal involvement. This is a dermatological emergency that requires immediate hospitalisation.

• VZV infection:

Shingles in children is uncommon. The primary lesion is a vesicle that develops into clusters on inflammatory skin. The pattern is metameric. Pain and burning are the primary symptoms. A swab sample can be taken for an HSV PCR test if there is any doubt about the diagnosis.

It was bullous impetigo.

Let’s rule out differential diagnoses:

• Pemphigus:

This is a rare condition but it can affect children; the bullae are fragile and the skin is not erythematous; most often, only post-bullous erosions are seen. The presence of mucosal involvement will aid the diagnosis. The appearance can be misleading and the outcome will not be favourable following antibiotic therapy, which will require a skin biopsy.

• Lyell’s syndrome:

The symptoms are intense. There is deterioration of the overall condition and the child is exhausted. Semiologically, there is “wet laundry” detachment with Nikolsky’s sign on intact skin and mucosal involvement. This is a dermatological emergency that requires immediate hospitalisation.

• VZV infection:

Shingles in children is uncommon. The primary lesion is a vesicle that develops into clusters on inflammatory skin. The pattern is metameric. Pain and burning are the primary symptoms. A swab sample can be taken for an HSV PCR test if there is any doubt about the diagnosis.

It was bullous impetigo.

Let’s rule out differential diagnoses:

• Pemphigus:

This is a rare condition but it can affect children; the bullae are fragile and the skin is not erythematous; most often, only post-bullous erosions are seen. The presence of mucosal involvement will aid the diagnosis. The appearance can be misleading and the outcome will not be favourable following antibiotic therapy, which will require a skin biopsy.

• Lyell’s syndrome:

The symptoms are intense. There is deterioration of the overall condition and the child is exhausted. Semiologically, there is “wet laundry” detachment with Nikolsky’s sign on intact skin and mucosal involvement. This is a dermatological emergency that requires immediate hospitalisation.

• VZV infection:

Shingles in children is uncommon. The primary lesion is a vesicle that develops into clusters on inflammatory skin. The pattern is metameric. Pain and burning are the primary symptoms. A swab sample can be taken for an HSV PCR test if there is any doubt about the diagnosis.