What is the best treatment for a cluster of blisters around the nose in children?

Treatment for Cluster of Blisters Around the Nose in Children

The best treatment for a cluster of blisters around the nose in children is topical mupirocin ointment applied three times daily for 7-10 days, as it has shown 71-93% clinical efficacy in treating impetigo, which is the most likely diagnosis.

Diagnosis: Impetigo

A cluster of blisters around the nose in children is most commonly impetigo, a highly contagious bacterial skin infection typically caused by Staphylococcus aureus or Streptococcus pyogenes. This condition presents as:

• Fluid-filled blisters that rupture easily
• Honey-colored crusts after blisters break
• Surrounding erythema
• Often located around the nose and mouth

First-Line Treatment

1. Topical Mupirocin 2% Ointment
   • Apply three times daily for 7-10 days 1
   • Clinical efficacy rates of 71-93% in treating impetigo 1
   • Particularly effective in children, with 78-96% efficacy rates in pediatric populations 1
   • Safe for use in children as young as 2 months 1

Supportive Care Measures

• Gently cleanse the affected area with warm water and mild soap before applying medication
• Avoid picking or scratching the lesions to prevent spread
• Use separate towels and washcloths to prevent transmission to other family members
• Trim the child's fingernails to minimize trauma and auto-inoculation
• Cover lesions with non-stick bandages if practical

When to Consider Alternative or Additional Treatment

For Moderate to Severe Cases:

If the infection is extensive (covering >2% of body surface area), systemic symptoms are present, or there's no improvement after 3-5 days of topical therapy:

• Oral Antibiotics: Consider oral antibiotics such as:
  • Amoxicillin-clavulanic acid
  • Cloxacillin
  • Cefalexin 2

For Suspected MRSA:

If there's concern for community-acquired MRSA or treatment failure:

• Alternative Oral Antibiotics:
  • Trimethoprim-sulfamethoxazole
  • Clindamycin 2

Special Considerations

• For Recurrent Infections: Consider nasal mupirocin application twice daily for 5 days to eradicate nasal carriage of S. aureus 3
• For Underlying Conditions: Assess for and treat conditions that may predispose to infection, such as atopic dermatitis or nasal allergies

When to Seek Further Medical Attention

Parents should be advised to seek further medical attention if:

• Lesions worsen or spread despite treatment
• Fever develops or persists
• Surrounding cellulitis develops
• Child appears systemically unwell
• No improvement after 3-5 days of treatment 1

Common Pitfalls to Avoid

1. Misdiagnosis: Don't confuse impetigo with other conditions like herpes simplex virus infection, which requires antiviral treatment
2. Inadequate Treatment Duration: Complete the full course of treatment even if lesions appear improved
3. Overuse of Antibiotics: Avoid unnecessary systemic antibiotics for limited disease
4. Neglecting Hygiene Measures: Proper hygiene is essential to prevent spread to other body sites or family members
5. Delayed Treatment: Early intervention prevents spread and complications

Topical mupirocin has been shown to be as effective as oral antibiotics for limited impetigo, with fewer systemic side effects, making it the optimal first-line treatment for typical cases of perinasal blisters in children 1.