Doctors’ Notes


Impetigo & MRSA

Skin is the largest organ in the body. From head to toe it forms a natural protective barrier. Even a small break in this remarkable protective layer, such as a small scratch, an insect bite, or a brush burn can allow bacteria to enter and lead to a localized skin infection. Two of the most common skin infections are IMPETIGO, and those caused by a germ called Methicillin Resistant Staphylococcus Aureus, or MRSA for short. I’m sure most of you have heard of this nasty, severely antibiotic resistant bug, from the news reports about infections in high school athletes.

Here are some things you should know about these two common infections.

IMPETIGO is a superficial skin infection, most commonly caused by the bacteria Streptococcus (Strep for short) and Staphylococcus Aureus (Staph for short). This particular strain of Staph is called Methicillin Sensitive Staph Aureus (MSSA). The drug Methicillin has been used to treat infections caused by Staph for several decades. But in the past ten years or so, this MSSA has outsmarted Methicillin and figured out a way, by genetic modification, to resist it. MSSA has, in many cases, become MRSA. No longer can we rely on Methicillin — or, for that matter, several other antibiotics normally used to treat infections caused by MRSA.


It can start as a small red bump, which quickly becomes a blister. This breaks open and becomes crusty and “icky.” Numerous such lesions can occur. Impetigo can occur on any part of the body, but a common site is on the face, around the nostril and chin areas. [To see an image of Impetigo: ]


A good daily scrubbing with soap and water can help. If there are only a couple of lesions, application of a topical antibiotic ointment, such as Mupirocin, three times daily for a week to ten days can help to clear the infection. If several lesions are present, it often requires an oral antibiotic for ten days.


This is a nasty bacterium that has become quite common in the last ten years or so, causing some commonly encountered skin lesions in the community. (Often referred to as Community-Acquired MRSA).


MRSA be very tricky to diagnose in the early stages. One must have a high index of suspicion! The initial lesion can look like a spider bite, and is often misdiagnosed as such. It is usually painful and tender, and can occur anywhere on the body. The lesion enlarges if untreated and becomes an abscess (boil). Once an abscess has formed, surgical drainage is almost always required. To see an image of MRSA, click here. ]

Penicillin, Amoxicillin, Augmentin, Cephalexin, and other antibiotics won’t touch this bug! The drainage (pus) is usually sent to a lab for proper identification and sensitivity testing, to see which antibiotic is best suited to fight it. Some of these antibiotics that can be  effective to  treat this MRSA are Clindamycin, Tmp/sulfa, Tetracycline, and, for severe cases, Vancomycin. Fortunately MRSA most commonly causes localized skin infections, but it is the cause of some very serious deep infections, including some in bone, joints, lungs, and other organs. Severe cases can at times lead to septic shock and death.

Some individuals tend to get recurrent MRSA skin infections due to what is called “ a carrier state.” These individuals can harbor these germs in their nose and anal areas. There is no foolproof way to prevent recurrences, but several experts have recommended Bleach (diluted Clorox) baths a few times a week and application of Mupirocin ointment inside the nose. But as soon as use of the nasal antibiotic stops, MRSA can recolonize! Hopefully ongoing research will come up with a new “Fix” to prevent recurrences.

Of course, GOOD HAND WASHING IS ALWAYS THE BEST WAY to decrease spread of infection!


If your child develops a skin lesion, that is open, crusty, “icky” looking, that is painful and tender, or that looks like a spider bite or a boil, call our office immediately.

Dr. K.G. Pai is the founding father of the Kids Plus practice family.