A 6-year-old girl presented to us with a 7-day history of genital eruption. She was initially diagnosed with eczema herpeticum and treated with systemic acyclovir without any improvement. On dermatologic examination, there were erosions and hematic crusts on the peri-nasal area, the chin, and the vulva. The vulvar area was erythematous with vesicles and crusted and eroded erythematous plaques surrounded by a collarette of blister roof (Fig. 1). The patient was afebrile and the remaining physical examination, including lymph nodes, was normal. Bacterial culture of vesicle fluid was positive for methicillin-sensitive Staphylococcus aureus. A diagnosis of bullous impetigo was made. The patient was treated with oral amoxicillin-clavulanic acid alongwith chlorhexidine body wash. The lesions fully resolved within four days.

Fig. 1 Vesicles, hematic crusts and scaling in a collarette over the genital area.

Genital bullous impetigo is an uncommon form of impetigo. It can be misdiagnosed for other vesiculating rashes such as varicella, eczema herpeticum, and linear IgA bullous dermatosis. However, it is distinguished clinically from these conditions by the presence of vesicles, flaccid blisters scaling in collarette, and children are well-appearing even in case of widespread bullous impetigo. Topical antibiotics are the first-choice treatment, and systemic antibiotic therapy is required in disseminated cases.