From the Guidelines
For erysipelas and impetigo on the face in children secondary to poison ivy, the first-line treatment is oral antibiotics, specifically cephalexin (Keflex) at a dose of 25-50 mg/kg/day divided into four doses for 7-10 days, as recommended by the Infectious Diseases Society of America guidelines 1. For children weighing less than 40 kg, the typical dose is 12.5-25 mg/kg every 6 hours, while children over 40 kg can receive 250-500 mg every 6 hours. Alternative options include clindamycin (10-30 mg/kg/day divided three times daily) if there is concern for methicillin-resistant Staphylococcus aureus (MRSA) or penicillin allergy, as suggested by the guidelines 1. Some key points to consider in the treatment of erysipelas and impetigo include:
- Topical mupirocin 2% ointment applied three times daily for 5-7 days can be used as an adjunct therapy for impetigo but is insufficient alone for erysipelas, as noted in the guidelines 1.
- The poison ivy component should be treated separately with topical corticosteroids such as triamcinolone 0.1% cream applied twice daily and oral antihistamines like cetirizine or diphenhydramine for itch relief, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1.
- Facial infections require systemic antibiotics rather than topical treatment alone due to the risk of complications and spread to nearby structures.
- Keep the affected area clean with gentle washing using mild soap and water twice daily, and advise against scratching to prevent further infection spread. It's also important to note that the treatment of poison ivy should be initiated as soon as possible after exposure, with washing of the exposed area with soap and water or a commercially available decontamination product, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1.
From the FDA Drug Label
The efficacy of topical Centany (mupirocin ointment),2% in impetigo was tested in one study. Centany (mupirocin ointment),2% is indicated for the topical treatment of impetigo due to: Staphylococcus aureus and Streptococcus pyogenes.
The first line treatment for impetigo on the face in children secondary to poison ivy is mupirocin ointment, 2%.
- Mupirocin has been shown to be effective in treating impetigo due to Staphylococcus aureus and Streptococcus pyogenes 2 2. However, there is no information in the provided drug labels about the treatment of Erysipelas. The FDA drug label does not answer the question about Erysipelas.
From the Research
Treatment Options for Erysipelas and Impetigo on the Face in Children
- The first line treatment for impetigo, which can be secondary to poison ivy, includes topical antibiotics such as mupirocin ointment 3, 4, 5.
- Topical mupirocin has been shown to be as effective as oral antibiotics and is associated with fewer adverse effects 3, 4.
- For limited disease, topical mupirocin and fusidic acid are equally or more effective than oral treatment 4, 5.
- Oral antibiotics, such as erythromycin, may be considered for patients with extensive disease 4, 5, 6.
- However, oral penicillin V is seldom effective, and resistance rates to erythromycin are rising 5.
- Topical disinfectants are not useful in the treatment of impetigo 5.
Considerations for Treatment
- The choice of therapy should take into account the resistance patterns of the causative micro-organisms 4, 6.
- Topical antibiotics, such as mupirocin, may be preferred due to their efficacy and lower risk of adverse effects compared to oral antibiotics 3, 4, 7.
- A shift towards topical antibiotics could decrease morbidity associated with the use of oral agents 7.
Specifics of Erysipelas Treatment
- There is limited information available on the treatment of erysipelas specifically, but it is often treated with oral antibiotics 4, 5.
- The treatment of erysipelas and impetigo on the face in children secondary to poison ivy should be guided by the severity of the disease and the presence of any underlying conditions 4, 5.