FIGURE 66.1 Folliculitis (Reprinted with permission from Burkhart C, Morrell D, Goldsmith LA, et al VisualDx: Essential Pediatric Dermatology Philadelphia, PA: Lippincott Williams & Wilkins; 2009.) Bullous Impetigo Bullous impetigo is caused by a localized staphylococcal infection that produces an exfoliative toxin that cleaves the skin connection desmoglein (DGS1) This allows fluid to build up within the epidermis and forms bullae ( Fig 66.3 ) When the bullae rupture, the roof of the bulla and the fluid dries to the skin giving the classic “honey-colored” crusting SA colonization is most common in the nares and perianal areas and thus impetigo is more common on the face and perineum Culture of the blister fluid will yield the pathogen and establish sensitivities for therapy Localized bullous impetigo can often be treated with topical antibiotics such as mupirocin, bacitracin, or retapamulin Systemic antibiotics should be used for more widespread or severe infections or those in immunosuppressed hosts, including neonates