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Your two-year-old has a runny nose for two weeks. You notice the skin under the nose becomes red and irritated. Two days later, the rash is worse, with thick crusty liquid oozing out. This sounds like impetigo.
It is a bacterial infection of the skin that can occur just about anywhere, but is most common around the mouth and nose or on the buttocks and arms. Impetigo may or may not itch. Scratching spreads the eruptions. Mild impetigo is often caused by streptococcus or staphylococcus. It occurs when the skin gets raw and irritated from scratching, runny nose, or excessive drooling. The bacteria may invade any area where the top protective layer of skin is broken down by an injury or irritation. Picking the skin around the nose or picking a pimple is an invitation for bacteria to come in and set up an infection.
It begins as tiny red spots, (resembling picked-at pimples) which become blisters that rupture and produce an oozing, sticky honey-colored crust on the surface. The spots are circular and may be as small as a dime or as large as a quarter. Impetigo is particularly common around the entrance to the nose, where the skin around the nostrils appears raw and reddened with a yellow crust.
For impetigo that seems mild and is just beginning, follow these steps three times a day:
If the infection continues to worsen despite the above treatment, then proceed with the following steps three times a day:
If you need the prescription ointment Bactroban, call or see your doctor. This generally would not warrant an urgent page to the doctor. If your doctor's office does not open for another day or two, then a call to your doctor for the ointment is probably warranted.
More serious infection. If the redness and drainage continue to worsen despite all the above treatment, or your child develops fevers or red streaks extending out from the area, then you should see your doctor right away. If it is after hours, you should page your doctor. Your child may need oral antibiotics to help fight the infection.