MRSA Skin Infection and Congenital Nevus in a 14-Year-Old Male
by: Ashley Baldree
At Village Dermatology in Katy and Houston, Texas, we treat a wide range of skin conditions in patients of all ages. In this case, we evaluated a 14-year-old male who presented with an itchy, red rash on his right leg that had been present for several months. The rash was moderate in severity and had not responded to prior home care.
Clinical Presentation
The patient and his mother reported persistent irritation and redness localized to the right lower leg. On examination, the rash displayed features consistent with impetigo, a superficial bacterial skin infection often caused by Staphylococcus aureus (including MRSA strains) or Streptococcus pyogenes. The lesions were crusted, and the patient admitted to scratching, which likely worsened the spread.
During the exam, we also identified a congenital nevus on the left forearm — a benign pigmented mole present since birth. While unrelated to the current rash, this finding was documented for ongoing monitoring.
Diagnosis
MRSA Skin Infection (Impetigo) — Common in children and highly contagious, often arising after minor skin trauma.
Congenital Nevus — A stable, benign mole with no current signs of malignancy.
Treatment Plan
For the MRSA skin infection, the following regimen was initiated:
Oral doxycycline twice daily for 10 days.
Topical mupirocin ointment applied three times daily for 5 days to the rash and inside the nostrils to reduce bacterial colonization.
Bleach baths as an adjunct to help lower bacterial presence on the skin’s surface.
The patient’s mother was counseled on the contagious nature of MRSA, the importance of completing all medications, and hygiene measures to prevent spread within the household.
For the congenital nevus, no immediate treatment was required. We recommended monthly self-skin checks and the use of broad-spectrum sunscreen SPF 30+ to protect against UV-related changes.
Follow-Up
The patient will return in one month for reassessment of the rash and to ensure complete resolution of the infection. Long-term monitoring of the congenital nevus will continue during routine visits.
Key Takeaways
Early diagnosis of MRSA skin infections is important to prevent spread and complications.
Combination therapy with oral and topical antibiotics, along with decolonization strategies, can be highly effective.
Even unrelated skin findings, like congenital nevi, should be documented and monitored for any changes.
