Power Point

Patient Initials: AB. Student: Lianet Aroche.

Date: 11/22/2023. Age: 10 y/o. Sex: Female

Allergies: NKDA Race: Hispanic.

SUBJECTIVE DATA

CC:

“My daughter has Skin rash ''.

HPI:

A 10 -year-old female teenager, Hispanic, is brought to the office by her mother, who stated

that her has a rash near the mouth, on the right side, which began as a mosquito bite that now

extends to several centimeters of the face and around the curve of the lip, The mother says that

the eruption began 4 days ago, and denies fever or other reported symptoms. Also denied

contact with a friends or relatives with similar lesions, no allergies were reported.

Current Medications:

Patient is not taking any regular medications or over-the-counter drugs. Also does not take any

supplements or any herbal supplements.

PMH: Negative for Chronic Disease. Unremarkable. Delivered at 39.2 W2D. Spontaneous

vaginal delivery was uneventful. Normal birth weight, Apgar score 8/9. DC two days after

delivery

Medication Intolerances: None

Chronic Illnesses/Major traumas: None

Screening Hx/Immunizations Hx: Vaccines reactivations updated. (Flu Vaccine, TT Reat;

Hib; Hep B, Covid).

Hospitalizations/Surgeries: None

Family History

Mother Alive: 36 y/o / Healthy

Father Alive: 40 y/o/ Healthy

1Sister Alive 16 Healthy

Negative Hx for Cancer, Dead for CV event, Genetical disease

Social History

Patient lives with his married parents in an apartment. Normal, familiar dynamic, he has a

healthy sister 14 y/o. He is a middle school student with good/normal development and social

interaction Denied smoke, alcohol intake and use or recreational drugs., No second-hand

smoking exposure. Denies being sexually active.

REVIEW OF SYSTEMS:

General

Patient denied change in appetite; tired,

weakness or sleep disorder.

Cardiovascular

Denies chest pain, palpitations, or edema on

the lower extremities. Deny varicosities or

history of DVT.

Skin

Refer her daugther has itching, and red rash

near lip right, no secretions, no burns, no

keloids.

Respiratory

Denies shortness of breath, hemoptysis,

wheezing, pleuritic pain or coughing.

Eyes

Denies any changes in vision. Denies any

trouble seeing clearly, pain, itching, or draining

of eyes. Does not use glasses. Last eye exam 1

year ago

GI

Denied appetite problems. No dysphagia.

Denies heartburn or bleeding. No

complaints of flatulence. Denies nausea or

vomiting. Denies hematochezia. No

diarrhea or constipation. Last bowel

movement: (today); Denies abdominal pain,

nausea, vomiting, diarrhea, constipation,

bowel habit changes, jaundice, vomiting

blood, blood in stool, tarry stools.

Ears

Patient denies pain or drainage from the ear,

hearing loss or tinnitus.

GU

Denies changes in urinary habits, normal

urinary frequency. Denies history of kidney

stones, flank pain, cloudy urine or bad

smell, denies being sexually active.

Nose/ Mouth/ Throat/Neck:

Denies sinus problems, dysphagia, nose bleeds

or discharge, loss of sense of smell, dry sinuses,

sinusitis, postnasal drip, sore tongue, bleeding

gums, sores in the mouth, loss of sense of taste,

dry mouth, frequent sore throats, hoarseness,

waking up with acid or bitter fluid in the mouth

or throat, food sticking in throat when swallows

or painful swallowing. Deny masses or pain on

neck or thyroid diseases.

Musculoskeletal

Patient refers no has history of falls

reported, denies weakness, muscular pain,

swollen or any other inflammatory

symptoms in the joints. Denies joint pain,

limited ROM, difficulty walking or trouble

reaching above head.

Psychiatric

Patients deny no changes in mood, denies

anxiety, depression, or insomnia.

Denies low self-esteem, feeling sad, social

isolation or attention deficit, no change in

thought patterns. Deny associated suicidal

ideas, nor mental illness in past.

Neurological

Denies loss of memory, seizures, seizures or

fainting lightheadedness, facial pain, gait

imbalance or changes in LOC. Denies

tremors, muscle weakness, numbness,

tingling or sleeping disturbances.

OBJECTIVE DATA:

Weight:

156 pns.

Height:

5`7”

BMI:

21.4 m2.

Temp:

97.2 oF

BP:

108/66 mmhg.

Pulse: 92 bmp Resp: 18 x min Pulse Ox: 99 % Pain scale 0/10.

PHYSICAL EXAMINATION:

General Appearance

Patient normal percentile according height and weight, properly dressed, speech clear and

appropriate, cooperative to the interview, alert, oriented in place, person, time. Discomfort due

to the pain is reflected in his face and posture. Well hydrated, well nourished

Skin

in the physical exam is presents small, red, itchy sores and blisters on the skin, especially

around the face (nose and mouth) and some low in extremities. The child experiences itching

and discomfort around the affected areas. The surrounding skin is red and slightly swollen.

HEENT

Head: Normocephalic, symmetric head, no signs of trauma. Normal sinuses, maxillary and

frontal palpation.

Eyes: No strabismus observed during exploration, normal extraocular muscle function, no

discharge from the eyes, sclera is white, conjunctiva pink. PERRLA.

Ears: Normal tragus and external canal. Meatus are normal. Not swollen or reddened. Bilateral

tympanic membranes were intact and pearly gray with light reflex. No erythematous, scarred

or hemorrhage. No pus or serous exudate. No hearing loss on bilateral whisper test.

Nose: No external deformities of the nose. Nasal mucosa moist and pink with clear drainage,

septum midline. Nasal turbinate no erythematous, no swollen. No sinus tenderness.

Oral Cavity: Oral mucosa moist and pink. No lesions suggestive of malignancy or infections.

Normal gums and palate, no bleeding or hypertrophy. Good hygiene, no caries or abscess

detectable to single inspection, normal dentition.

Pharynx: Moist and pink, no presence of plaques or exudate. No petechias, no strawberry

tongue. Normal pharynx and uvula to inspection, gag reflex presents and unaltered.

Neck: No visible mass. No lymphadenopathy noted. Thyroid in the middle, no palpable. No

palpable masses or tenderness, trachea is midline. No JVD.

Cardiovascular

Normal chest wall, absence of orthopnea, collateral circulation or edema on lower extremities,

no clubbing or cyanosis observed. No pericardial friction rub heard. Regular rate and rhythm,

heart sounds of S1 and S2, no bruits, murmurs found to auscultation, no extra heart sounds,

PMI at 5th intercostal space, midclavicular line. No pericardial friction rub heard. No gallops,

murmurs, or opening snaps. Carotid, apical, radial femoral and pedal pulses present and

strong, capillary refill 2 seconds.

Respiratory

On inspection, the chest is symmetrical and moves with respiration, No osseous abnormality,

scars, hematomas, or edema. Normal thoracic breathing, no use of accessory muscle, no tripod

position. On palpation, no masses or crepitus, tactile fremitus equal bilaterally. On percussion,

resonance. On auscultation, clear lung without adventitious sounds.

Gastrointestinal

Abdomen: Inspection: Symmetric, is watched flat, nondistended, no visible masses. No scars

Auscultation: Bowel sound active in all 4 quadrants. No bruits. Palpation: soft, no pain when

palpating the abdomen, no involuntary guarding or rebound tenderness observed, no signs of

peritoneal irritation, no palpable masses. No hepatomegaly or splenomegaly. Percussion:

Normal.

Genitourinary

Bimanual palpation does not reveal signs of enlarged kidneys. Costovertebral angles do not

reveal tenderness. No palpable or percussed bladder.

Musculoskeletal

Normal gait. No muscular atrophies observed, no evident deformities, no stiffness observed,

range of motion within normal limited, normal joints. Fingers, feet, and toes are normal. Spine

without deformity.

Neurological

AAOx3. Keeps adequate communication ability, no concentration or attention deficit noted

during the exploration. Normal gait and balance observed. Sensation intact. Normal motor

activity. Deep tendon reflexes symmetrical and equal bilaterally. Normal function of all cranial

nerves (from I to XII). Bilateral UE/LE strength 5/5.

Psychiatric:

Patient is euthymic, with normal level of mood, language and communication. The affect was

normal. No past medical condition previous, no depression signs, no suicidal ideas presented.

Main Diagnosis:

ICD 10: L01.00: Impetigo, is a bacterial infection that involves the superficial skin. The most

common presentation is yellowish crusts on the face, arms, or legs. Less commonly there may

be large blisters which affect the groin or armpits. The lesions may be painful or itchy. Fever

is uncommon. This most common form of impetigo, also called nonbullies impetigo, most

often begins as a red sore near the nose or mouth which soon breaks, leaking pus or fluid, and

forms a honey-colored scab, followed by a red mark which heals without leaving a scar. Sores

are not painful, but they may be itchy. Lymph nodes in the affected area may be swollen, but

fever is rare. Touching or scratching the sores may easily spread the infection to other parts of

the body. (Hartman-Adams H, Banvard C, Juckett G.).

Differential Diagnosis

B00.9; Herpes viral infection, unspecified. Herpes viral infections in children refer to a group

of viral infections caused by the herpes simplex viruses (HSV). There are two main types of

herpes simplex viruses: HSV-1 and HSV-2. These viruses can cause a range of clinical

manifestations, including oral herpes (HSV-1), genital herpes (usually caused by HSV-2 but

can also be caused by HSV-1), and other less common infections. Oral Herpes (HSV-1): Oral

herpes is commonly known as "cold sores" or "fever blisters." It typically presents as painful,

fluid-filled blisters or sores on or around the lips, mouth, or gums. And Genital Herpes (HSV-

2 or HSV-1): Genital herpes in children is less common than in adults but can occur, usually

due to sexual abuse. It presents as painful sores or blisters in the genital or anal area.

Treatment with antiviral medications is typically necessary to manage symptoms and reduce

the risk of complications. Herpes Gladiatorum (HSV-1): Also known as "mat herpes," this

condition can affect children participating in contact sports like wrestling. It presents as

clusters of painful blisters on the face, neck, or other exposed areas of the body. (Hartman-

Adams H, Banvard C, Juckett G.)

ICD 10: B01.9; Varicella without complication. Varicella, commonly known as chickenpox, is

a contagious viral infection that primarily affects children. It is caused by the varicella-zoster

virus (VZV), which belongs to the herpesvirus family. Chickenpox is characterized by a

distinctive rash of itchy, fluid-filled blisters and is typically a mild childhood illness. Here's a

description of varicella in children: Initial Symptoms: Chickenpox typically begins with a few

days of mild, flu-like symptoms, including: Fever, Fatigue, Loss of appetite, Headache and

Rash development: After the initial symptoms, a rash appears. This rash is a hallmark of

chickenpox and progresses through several stages: Red Spots: Small, red, itchy spots develop

on the skin. These can appear anywhere on the body. (Bowen AC, Mahé A, Hay RJ, et al.).

ICD 10: L73.9; Follicular disorder, unspecified. Follicular disorders in children refer to a

group of skin conditions that affect hair follicles. These disorders can result in a variety of

symptoms and can be caused by various factors. Here are a few examples of follicular

disorders that can occur in children: Folliculitis: Folliculitis is a common condition in which

hair follicles become inflamed. It can occur in children and is often caused by bacterial or

fungal infections. It presents small red or pimple-like bumps around hair follicles and can be

itchy or painful. Keratosis Pilaris: This is a common and usually harmless skin condition that

can affect children. It results in small, raised bumps on the skin, often on the arms, thighs, or

buttocks. These bumps are caused by the buildup of keratin, a protein that can block hair

follicles. And others disease. (Elliot AJ, Cross KW, Smith GE, et al.).

Plan:

Lab exams: no at this time.

Medications:

Amoxicillin 250 mg 1 tab PO every 6 hours x 7 days

(Considered oral antibiotics (e.g., cephalexin, dicloxacillin) for more extensive or severe cases

of impetigo or if multiple family members are affected. And Prescribed antibiotics as needed,

and provide clear instructions on dosage and duration of treatment.)

Mupirocin 2% topical ointment apply in lesions 3 x times per day.

Ibuprofen 400 mg1 tab each 8 hrs orally.

Preventions:

Emphasize the importance of handwashing with soap and water before and after touching the

affected areas.

Encourage good personal hygiene practices, including daily baths or showers.

Recommended using a mild, antibacterial soap to clean the affected areas gently.

Advise against sharing towels, clothing, or personal items to prevent the spread of the

infection.

Washing hands, linens, and affected areas will lower the likelihood of contact with infected

fluids.

Scratching can spread the sores; keeping nails short will reduce the chances of spreading.

Infected people should avoid contact with others and eliminate sharing of clothing or linens.

Children with impetigo can return to school 24 hours after starting antibiotic therapy as long as

their draining lesions are covered.

Infection Control Measures at Home: Disinfect surfaces, toys, and clothing that may have

come into contact with the child's skin.

Wash and change bed linens, towels, and clothing regularly to prevent reinfection.

Monitoring and Follow-Up:

Follow-up in 1 week. Schedule follow-up appointments to monitor the progress of treatment

and ensure that the infection is resolving. Assess for any complications or the development of

new lesions.

Referral: No.

References:

Hartman-Adams H, Banvard C, Juckett G. (2021), Impetigo: diagnosis and treatment. Am

Fam Physician.; 90 (4):229-35.

Bowen AC, Mahé A, Hay RJ, et al. (2020), The global epidemiology of impetigo: a systematic

review of the population prevalence of impetigo and pyoderma.; 10 (8): 0136789.

Elliot AJ, Cross KW, Smith GE, et al. (2021), The association between impetigo, insect bites

and air temperature: a retrospective 5-year study (1999-2019) using morbidity data collected

from a sentinel general practice network database. (5): 490-6.

Patient Initials: AB. Student: Lianet Aroche.

Date: 11/22/2023. Age: 10 y/o. Sex: Female

Allergies: NKDA Race: Hispanic.

SUBJECTIVE DATA

CC:

“My daughter has Skin rash ''.

HPI:

A 10 -year-old female teenager, Hispanic, is brought to the office by her mother, who stated

that her has a rash near the mouth, on the right side, which began as a mosquito bite that now

extends to several centimeters of the face and around the curve of the lip, The mother says that

the eruption began 4 days ago, and denies fever or other reported symptoms. Also denied

contact with a friends or relatives with similar lesions, no allergies were reported.

Current Medications:

Patient is not taking any regular medications or over-the-counter drugs. Also does not take any

supplements or any herbal supplements.

PMH: Negative for Chronic Disease. Unremarkable. Delivered at 39.2 W2D. Spontaneous

vaginal delivery was uneventful. Normal birth weight, Apgar score 8/9. DC two days after

delivery

Medication Intolerances: None

Chronic Illnesses/Major traumas: None

Screening Hx/Immunizations Hx: Vaccines reactivations updated. (Flu Vaccine, TT Reat;

Hib; Hep B, Covid).

Hospitalizations/Surgeries: None

Family History

Mother Alive: 36 y/o / Healthy

Father Alive: 40 y/o/ Healthy

1Sister Alive 16 Healthy

Negative Hx for Cancer, Dead for CV event, Genetical disease

Social History

Patient lives with his married parents in an apartment. Normal, familiar dynamic, he has a

healthy sister 14 y/o. He is a middle school student with good/normal development and social

interaction Denied smoke, alcohol intake and use or recreational drugs., No second-hand

smoking exposure. Denies being sexually active.

REVIEW OF SYSTEMS:

General

Patient denied change in appetite; tired,

weakness or sleep disorder.

Cardiovascular

Denies chest pain, palpitations, or edema on

the lower extremities. Deny varicosities or

history of DVT.

Skin

Refer her daugther has itching, and red rash

near lip right, no secretions, no burns, no

keloids.

Respiratory

Denies shortness of breath, hemoptysis,

wheezing, pleuritic pain or coughing.

Eyes

Denies any changes in vision. Denies any

trouble seeing clearly, pain, itching, or draining

of eyes. Does not use glasses. Last eye exam 1

year ago

GI

Denied appetite problems. No dysphagia.

Denies heartburn or bleeding. No

complaints of flatulence. Denies nausea or

vomiting. Denies hematochezia. No

diarrhea or constipation. Last bowel

movement: (today); Denies abdominal pain,

nausea, vomiting, diarrhea, constipation,

bowel habit changes, jaundice, vomiting

blood, blood in stool, tarry stools.

Ears

Patient denies pain or drainage from the ear,

hearing loss or tinnitus.

GU

Denies changes in urinary habits, normal

urinary frequency. Denies history of kidney

stones, flank pain, cloudy urine or bad

smell, denies being sexually active.

Nose/ Mouth/ Throat/Neck:

Denies sinus problems, dysphagia, nose bleeds

or discharge, loss of sense of smell, dry sinuses,

sinusitis, postnasal drip, sore tongue, bleeding

gums, sores in the mouth, loss of sense of taste,

dry mouth, frequent sore throats, hoarseness,

waking up with acid or bitter fluid in the mouth

or throat, food sticking in throat when swallows

or painful swallowing. Deny masses or pain on

neck or thyroid diseases.

Musculoskeletal

Patient refers no has history of falls

reported, denies weakness, muscular pain,

swollen or any other inflammatory

symptoms in the joints. Denies joint pain,

limited ROM, difficulty walking or trouble

reaching above head.

Psychiatric

Patients deny no changes in mood, denies

anxiety, depression, or insomnia.

Denies low self-esteem, feeling sad, social

isolation or attention deficit, no change in

thought patterns. Deny associated suicidal

ideas, nor mental illness in past.

Neurological

Denies loss of memory, seizures, seizures or

fainting lightheadedness, facial pain, gait

imbalance or changes in LOC. Denies

tremors, muscle weakness, numbness,

tingling or sleeping disturbances.

OBJECTIVE DATA:

Weight:

156 pns.

Height:

5`7”

BMI:

21.4 m2.

Temp:

97.2 oF

BP:

108/66 mmhg.

Pulse: 92 bmp Resp: 18 x min Pulse Ox: 99 % Pain scale 0/10.

PHYSICAL EXAMINATION:

General Appearance

Patient normal percentile according height and weight, properly dressed, speech clear and

appropriate, cooperative to the interview, alert, oriented in place, person, time. Discomfort due

to the pain is reflected in his face and posture. Well hydrated, well nourished

Skin

in the physical exam is presents small, red, itchy sores and blisters on the skin, especially

around the face (nose and mouth) and some low in extremities. The child experiences itching

and discomfort around the affected areas. The surrounding skin is red and slightly swollen.

HEENT

Head: Normocephalic, symmetric head, no signs of trauma. Normal sinuses, maxillary and

frontal palpation.

Eyes: No strabismus observed during exploration, normal extraocular muscle function, no

discharge from the eyes, sclera is white, conjunctiva pink. PERRLA.

Ears: Normal tragus and external canal. Meatus are normal. Not swollen or reddened. Bilateral

tympanic membranes were intact and pearly gray with light reflex. No erythematous, scarred

or hemorrhage. No pus or serous exudate. No hearing loss on bilateral whisper test.

Nose: No external deformities of the nose. Nasal mucosa moist and pink with clear drainage,

septum midline. Nasal turbinate no erythematous, no swollen. No sinus tenderness.

Oral Cavity: Oral mucosa moist and pink. No lesions suggestive of malignancy or infections.

Normal gums and palate, no bleeding or hypertrophy. Good hygiene, no caries or abscess

detectable to single inspection, normal dentition.

Pharynx: Moist and pink, no presence of plaques or exudate. No petechias, no strawberry

tongue. Normal pharynx and uvula to inspection, gag reflex presents and unaltered.

Neck: No visible mass. No lymphadenopathy noted. Thyroid in the middle, no palpable. No

palpable masses or tenderness, trachea is midline. No JVD.

Cardiovascular

Normal chest wall, absence of orthopnea, collateral circulation or edema on lower extremities,

no clubbing or cyanosis observed. No pericardial friction rub heard. Regular rate and rhythm,

heart sounds of S1 and S2, no bruits, murmurs found to auscultation, no extra heart sounds,

PMI at 5th intercostal space, midclavicular line. No pericardial friction rub heard. No gallops,

murmurs, or opening snaps. Carotid, apical, radial femoral and pedal pulses present and

strong, capillary refill 2 seconds.

Respiratory

On inspection, the chest is symmetrical and moves with respiration, No osseous abnormality,

scars, hematomas, or edema. Normal thoracic breathing, no use of accessory muscle, no tripod

position. On palpation, no masses or crepitus, tactile fremitus equal bilaterally. On percussion,

resonance. On auscultation, clear lung without adventitious sounds.

Gastrointestinal

Abdomen: Inspection: Symmetric, is watched flat, nondistended, no visible masses. No scars

Auscultation: Bowel sound active in all 4 quadrants. No bruits. Palpation: soft, no pain when

palpating the abdomen, no involuntary guarding or rebound tenderness observed, no signs of

peritoneal irritation, no palpable masses. No hepatomegaly or splenomegaly. Percussion:

Normal.

Genitourinary

Bimanual palpation does not reveal signs of enlarged kidneys. Costovertebral angles do not

reveal tenderness. No palpable or percussed bladder.

Musculoskeletal

Normal gait. No muscular atrophies observed, no evident deformities, no stiffness observed,

range of motion within normal limited, normal joints. Fingers, feet, and toes are normal. Spine

without deformity.

Neurological

AAOx3. Keeps adequate communication ability, no concentration or attention deficit noted

during the exploration. Normal gait and balance observed. Sensation intact. Normal motor

activity. Deep tendon reflexes symmetrical and equal bilaterally. Normal function of all cranial

nerves (from I to XII). Bilateral UE/LE strength 5/5.

Psychiatric:

Patient is euthymic, with normal level of mood, language and communication. The affect was

normal. No past medical condition previous, no depression signs, no suicidal ideas presented.

Main Diagnosis:

ICD 10: L01.00: Impetigo, is a bacterial infection that involves the superficial skin. The most

common presentation is yellowish crusts on the face, arms, or legs. Less commonly there may

be large blisters which affect the groin or armpits. The lesions may be painful or itchy. Fever

is uncommon. This most common form of impetigo, also called nonbullies impetigo, most

often begins as a red sore near the nose or mouth which soon breaks, leaking pus or fluid, and

forms a honey-colored scab, followed by a red mark which heals without leaving a scar. Sores

are not painful, but they may be itchy. Lymph nodes in the affected area may be swollen, but

fever is rare. Touching or scratching the sores may easily spread the infection to other parts of

the body. (Hartman-Adams H, Banvard C, Juckett G.).

Differential Diagnosis

B00.9; Herpes viral infection, unspecified. Herpes viral infections in children refer to a group

of viral infections caused by the herpes simplex viruses (HSV). There are two main types of

herpes simplex viruses: HSV-1 and HSV-2. These viruses can cause a range of clinical

manifestations, including oral herpes (HSV-1), genital herpes (usually caused by HSV-2 but

can also be caused by HSV-1), and other less common infections. Oral Herpes (HSV-1): Oral

herpes is commonly known as "cold sores" or "fever blisters." It typically presents as painful,

fluid-filled blisters or sores on or around the lips, mouth, or gums. And Genital Herpes (HSV-

2 or HSV-1): Genital herpes in children is less common than in adults but can occur, usually

due to sexual abuse. It presents as painful sores or blisters in the genital or anal area.

Treatment with antiviral medications is typically necessary to manage symptoms and reduce

the risk of complications. Herpes Gladiatorum (HSV-1): Also known as "mat herpes," this

condition can affect children participating in contact sports like wrestling. It presents as

clusters of painful blisters on the face, neck, or other exposed areas of the body. (Hartman-

Adams H, Banvard C, Juckett G.)

ICD 10: B01.9; Varicella without complication. Varicella, commonly known as chickenpox, is

a contagious viral infection that primarily affects children. It is caused by the varicella-zoster

virus (VZV), which belongs to the herpesvirus family. Chickenpox is characterized by a

distinctive rash of itchy, fluid-filled blisters and is typically a mild childhood illness. Here's a

description of varicella in children: Initial Symptoms: Chickenpox typically begins with a few

days of mild, flu-like symptoms, including: Fever, Fatigue, Loss of appetite, Headache and

Rash development: After the initial symptoms, a rash appears. This rash is a hallmark of

chickenpox and progresses through several stages: Red Spots: Small, red, itchy spots develop

on the skin. These can appear anywhere on the body. (Bowen AC, Mahé A, Hay RJ, et al.).

ICD 10: L73.9; Follicular disorder, unspecified. Follicular disorders in children refer to a

group of skin conditions that affect hair follicles. These disorders can result in a variety of

symptoms and can be caused by various factors. Here are a few examples of follicular

disorders that can occur in children: Folliculitis: Folliculitis is a common condition in which

hair follicles become inflamed. It can occur in children and is often caused by bacterial or

fungal infections. It presents small red or pimple-like bumps around hair follicles and can be

itchy or painful. Keratosis Pilaris: This is a common and usually harmless skin condition that

can affect children. It results in small, raised bumps on the skin, often on the arms, thighs, or

buttocks. These bumps are caused by the buildup of keratin, a protein that can block hair

follicles. And others disease. (Elliot AJ, Cross KW, Smith GE, et al.).

Plan:

Lab exams: no at this time.

Medications:

Amoxicillin 250 mg 1 tab PO every 6 hours x 7 days

(Considered oral antibiotics (e.g., cephalexin, dicloxacillin) for more extensive or severe cases

of impetigo or if multiple family members are affected. And Prescribed antibiotics as needed,

and provide clear instructions on dosage and duration of treatment.)

Mupirocin 2% topical ointment apply in lesions 3 x times per day.

Ibuprofen 400 mg1 tab each 8 hrs orally.

Preventions:

Emphasize the importance of handwashing with soap and water before and after touching the

affected areas.

Encourage good personal hygiene practices, including daily baths or showers.

Recommended using a mild, antibacterial soap to clean the affected areas gently.

Advise against sharing towels, clothing, or personal items to prevent the spread of the

infection.

Washing hands, linens, and affected areas will lower the likelihood of contact with infected

fluids.

Scratching can spread the sores; keeping nails short will reduce the chances of spreading.

Infected people should avoid contact with others and eliminate sharing of clothing or linens.

Children with impetigo can return to school 24 hours after starting antibiotic therapy as long as

their draining lesions are covered.

Infection Control Measures at Home: Disinfect surfaces, toys, and clothing that may have

come into contact with the child's skin.

Wash and change bed linens, towels, and clothing regularly to prevent reinfection.

Monitoring and Follow-Up:

Follow-up in 1 week. Schedule follow-up appointments to monitor the progress of treatment

and ensure that the infection is resolving. Assess for any complications or the development of

new lesions.

Referral: No.

References:

Hartman-Adams H, Banvard C, Juckett G. (2021), Impetigo: diagnosis and treatment. Am

Fam Physician.; 90 (4):229-35.

Bowen AC, Mahé A, Hay RJ, et al. (2020), The global epidemiology of impetigo: a systematic

review of the population prevalence of impetigo and pyoderma.; 10 (8): 0136789.

Elliot AJ, Cross KW, Smith GE, et al. (2021), The association between impetigo, insect bites

and air temperature: a retrospective 5-year study (1999-2019) using morbidity data collected

from a sentinel general practice network database. (5): 490-6.