Impetigo vs Herpes and eczema herpeticum
How to tell Impetigo and Herpes and eczema herpeticum apart when a board question makes them look alike.
Impetigo is honey-crusted bacterial erosion; herpes is grouped vesicles; eczema herpeticum is disseminated punched-out HSV in atopic skin.
Side by side
Impetigo causes superficial honey-colored crusted erosions, often from Staph aureus or Strep pyogenes in children.
Herpes causes grouped painful vesicles on erythematous base; eczema herpeticum is disseminated HSV with punched-out erosions in atopic dermatitis and systemic illness.
Bacterial infection of superficial epidermis creates crusted erosions or bullae.
HSV infects keratinocytes and spreads locally or disseminates in impaired skin barrier.
Honey-colored crusts and superficial culture with staph or strep support impetigo.
Grouped vesicles, multinucleated giant cells, or punched-out erosions on eczema support HSV/eczema herpeticum.
The trap
Crusted erosions can overlap after rupture, so distribution, pain, vesicles, atopy, and systemic illness separate them.
The repair move
For crusted pediatric rashes, decide bacterial honey crust versus HSV vesicles or punched-out erosions.
Try a free question
CoreA 5-year-old girl has 4 days of yellow-crusted erosions around the nose and mouth that started as small vesicles and pustules. There is no fever. The lesions are honey-colored. Which diagnosis is most likely?
Show answer and explanation
Answer: A. Impetigo. Impetigo is a superficial bacterial infection (Staphylococcus aureus or Streptococcus pyogenes) with characteristic honey-colored crusted erosions, classically around the nose and mouth in children; treatment is topical mupirocin for limited disease or oral cephalexin/dicloxacillin for extensive disease.
Why the other choices are tempting
- B. Primary herpes simplex has grouped vesicles on an erythematous base, often with fever and lymphadenopathy.
- C. Eczema herpeticum is HSV disseminated in atopic dermatitis with punched-out erosions.
- D. Atopic dermatitis has chronic pruritic lichenified flexural patches.
- E. Folliculitis has follicle-centered pustules without honey crust.
Flashcards
Tap a card to flip it.
What crust supports impetigo?
Honey-colored crust supports superficial bacterial impetigo rather than grouped vesicles from herpes.
What setting supports eczema herpeticum?
Atopic dermatitis with disseminated punched-out HSV erosions supports eczema herpeticum.
Quick answers
What is the fastest way to tell Impetigo from Herpes and eczema herpeticum?
Impetigo is honey-crusted bacterial erosion; herpes is grouped vesicles; eczema herpeticum is disseminated punched-out HSV in atopic skin.
What is the key clue for Impetigo?
Impetigo causes superficial honey-colored crusted erosions, often from Staph aureus or Strep pyogenes in children.
What is the key clue for Herpes and eczema herpeticum?
Herpes causes grouped painful vesicles on erythematous base; eczema herpeticum is disseminated HSV with punched-out erosions in atopic dermatitis and systemic illness.
What is the common trap with Impetigo vs Herpes and eczema herpeticum?
Crusted erosions can overlap after rupture, so distribution, pain, vesicles, atopy, and systemic illness separate them.