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Ask A Skin Doctor: Bullous Impetigo

Dear Doctor

I had a mysterious rash show up on the left side of my forehead a little over 3 days ago. It was very sudden. It started as one open sore then quickly expanded. The surrounding skin got inflamed, red and blistery.

Then there were 4 open sores with surrounding red, thin, dead-looking skin that basically takes up the entire left side of my forehead.

I saw a dermatologist who assumed it was bullous impetigo. She put me on antibiotics as well as an antiviral (in case it was shingles) and took cultures.

I just heard back and the shingles culture came back negative and the bacterial culture hasn’t grown anything (“yet” she says).

I’ve seen little to no improvement in the appearance since I went in to see her on Monday but it also hasn’t worsened. Just remains stagnant.

It doesn’t itch and a very, very slight stinging feeling only every now and then. Mostly it’s just unsightly.

Do you have any ideas? I’m very panicked right now as I feel like I’m getting no answers.  Thank you.

bullous impetigo

Dear Patient

Bullous impetigo and herpes zoster (shingles) can both begin with similar symptoms of blisters which rupture and develop into sores.

However, the 4 open sores with surrounding red, thin, dead-looking skin is more suggestive of bullous impetigo which is characterized by a rim of scale that surrounds the red sore after the blisters burst.

At this stage it is hard to say what we are dealing with since all we can see from your photo is just some erythema (redness). This is complicated by the fact that you have been taking antibiotics to cover the bullous impetigo and antivirals to cover shingles.

I therefore advise you to complete the treatment that has been prescribed by taking both the antibiotics and antivirals because if herpes zoster affects that part of the face and it is not treated effectively it can affect the eye and cause blindness.

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