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Child has cluster vesicular skin rash, tender. Taken Flucloxacillin, fusidic acid. Can it be shingles?

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Hi, My 2.5 year old son has developed a cluster vesicular skin rash. I am a doctor myself but not sure what this is. Can you help?

cluster vesicular rasher with red base. spread over the last 4 days. a bit tender not particularly itchy. Only on the left arm and left side of the chest. does not cross the midline. He is generally well, no fever. good appetite, systemically very well.

The clusters have a center which has crusted over already with fresh vesicles around it. The crust is red and not gold.

We don't think he had chicken pox before but this is not typical for chicken pox either. Can it be Shingles?

His doctor started Flucloxacillin and fusidic acid to prevent secondary infection and to cover for possible impetigo.

As Shingles without Chicken pox at this age is unusual, is there anything more likely that we are missing?
Should we consider VZIG for for our 11-day old? Mum was immune to Chicken pox.

I have attached a picture.

Posted Tue, 24 Apr 2012 in Skin Hair and Nails
Answered by Dr. Bharat Chawda 17 hours later

Thank you for posting the query.

You have provided with good information regarding your son's skin problem and it is a very good description. I appreciate it.

It was good that you had already posted the picture. By the look it seems to be Impetigo. The other possibility which came into my mind while I was going through the mail (without looking at the picture) was Insect bite reaction (IBR), which usually manifests as linear vesicles with burning sensation.

But the picture clarifies the condition. Since the vesicles are not linear, but in-fact spread out and also contact blisters have also developed, the possibility of Impetigo is more likely.

Also in Impetigo, patient complains of pain and in IBR one complains of burning and itching sensation. In Impetigo one also observes brown crusted lesions as seen in your son's case.

Impetigo also becomes more common in atopic patient's.

In chicken pox one doesn't get these big listers and they are never so close by or grouped, instead they are more discrete and mainly over chest.

Herpes (shingles) is seen only when one has suffered from from chicken pox.

At the moment, I think he is on right treatment. But instead of Fusidic acid, I would have preferred Mupirocin cream. You can consider this, if the lesions does not heal with current treatment.

I would suggest you to consult your dermatologist again to confirm the cause. Regarding VZIG vaccine for your 11 year old baby, you can discuss the same with your doctor after confirming the cause. If the rash is confirmed due to Impetigo, VZIG will not be required.

Hope I have answered your query. Should you have additional concerns regarding this issue, I would be happy to address them.

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Follow-up: Child has cluster vesicular skin rash, tender. Taken Flucloxacillin, fusidic acid. Can it be shingles? 6 hours later
Thank you Dr. Chawda for your careful consideration and reply to the case.

In fact, today, he developed another similar lesion on the other arm, which is against the diagnosis of shingles. (I was still considering shingles, thinking perhaps he has a subclinical chicken pox that we have missed).

Should I worry about the occurrence of Impetigo in my son, in both arms? I mean should we be worried about immunodeficiency?

would you normally swab these lesions to confirm Impetigo?

I am taking him to see one of my dermatologist colleagues tomorrow but in the meantime, thank you for your kind attention.

Best wishes,

Answered by Dr. Bharat Chawda 12 hours later

Thank you for the reply,

The lesions still seems to be Impetigo to me at present,provided he doesn't get any oral lesions (oral ulcers or erosion) or at other parts of the body .

One can go for a bacterial culture and sensitivity(swab) if needed just to select a proper antibiotic.

Chronic bullous disease of childhood (CBDC) is another condition where one gets multiple blisters mainly around the oral and perineum area.In such condition we should get a skin biopsy also.

I am happy to learn that you are consulting a dermatologist at your place who can take a more rational decision after looking at the condition clinically.

In Atopic dermatitis patient we do come across such staphylococcus infection very frequently ,but shouldn't be a recurrent problem,provided you take all the precautions one takes in atopic patients.

I thank you again for submitting your question. I hope you found my response to be helpful and informative. If you have any additional concerns I would be happy to address them.

Best Regards,

Dr.Bharat chawda
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