treat this infection the same as cellulitis, which is outlined earlier. Adjunctive treatment and complications are the same as for cellulitis. Impetigo Impetigo is most commonly seen in children aged two to five years and is classified as bullous or nonbullous (Table 1). The nonbullous type predominates and presents with an erosion (sore), cluster of erosions, or small vesicles or pustules that have an adherent or oozing honey-yellow crust. The predilection for the very young can be remembered by the common lay misnomer, “infant tigo.” Impetigo usually appears in areas where there is a break in the skin, such as a wound, herpes simplex infection, or maceration associated with angular cheilitis (Figure 4), but Staphylococcus aureus can directly invade the skin and cause a de novo infection.6 The bullous form of impetigo presents as a large thin-walled bulla (2 to 5 cm) containing serous yellow fluid. It often ruptures leaving a complete or partially denuded area with a ring or arc of remaining bulla (Figure 5). More than one area may be involved and a mix of bullous and nonbullous findings can exist. Nonbullous impetigo was previously thought to be a group A streptococcal process and bullous impetigo was primarily thought to be caused by S. aureus. Studies16,17 now indicate that both forms of impetigo are primarily caused by S. aureus with Streptococcus usually being involved in the nonbullous form. If the infection is a toxin-producing, phage group II, type 71 Staphylococcus (the same toxin seen in Staphylococcus scalded skin syndrome, a medical emergency where large sheets of the upper epidermis slough off), large bullae will form as the toxin produces intradermal cleavage.18 Otherwise, smaller bullae develop and the honey-crusted lesions predominate. Ruptured bullous impetigo. A study19 published in 1990 concluded that topical mupirocin (Bactroban) ointment is as effective as oral erythromycin in treating impetigo. However, because the lesions of bullous impetigo can be large and both forms of impetigo can have satellite lesions, an oral antibiotic with activity against S. aureus and group A beta-hemolytic streptococcal infection is warranted in nonlocalized cases. Because of developing resistance, erythromycin is no longer the drug of choice.17 Azithromycin (Zithromax) for five days and cephalexin (Keflex) for 10 days have been shown to be effective and well-tolerated.20 Dicloxacillin (Pathocil), oxacillin (Prostaphlin), first-generation cephalosporins, or amoxicillin-clavulanate are also acceptable alternatives.5 Broad-spectrum fluoroquinolones have also been shown to be effective, and several have been approved by the U.S. Food and Drug Administration for treating skin and soft tissue infections.21 These medications have excellent skin penetration and good bioavailability, but no generic forms are currently available, and they are only approved for use in adults. As with other diseases involving Streptococci, there is a small chance of developing glomerulonephritis, especially in children aged two to six years. Presenting signs and symptoms of glomerulonephritis include edema and hypertension; about one third of patients have smoky or tea-colored urine. Streptococcal glomerulonephritis usually resolves spontaneously although acute symptoms and problems may occur.22 Impetigo can be spread by direct person-to-person contact, so appropriate hygiene is warranted. Nasal carriage of S. aureus has been implicated as a source of recurrent disease and can be reduced by the topical application of mupirocin twice daily for five days.23 Folliculitis Hair follicles can become inflamed by physical injury, chemical irritation, or infection that leads to folliculitis Classification is by the depth of involvement of the hair follicle. The most common form is superficial folliculitis that manifests as a tender or painless pustule that heals without scarring.24 The hair shaft will frequently be seen in the center of the pustule. Multiple or single lesions can appear on any skin bearing hair including the head, neck, trunk, buttocks, and extremities. Associated systemic symptoms or fever rarely exist. S. aureus is the most likely pathogen; however, commensal organisms such as yeast and fungi occasionally