Blistering eruption in a Latino migrant farmworker

Skin rashes are among the most common problems seen by those providing health care to agricultural workers. We present a case report of a migrant farmworker patient with a painful, blistering eruption of the axilla and adjacent skin developing after an insect bite. The possibility of infection was not initially considered, and teledermatology was helpful in making the diagnosis of bullous impetigo. This was important because initial culture confirmation was not obtained and antibiotic treatment had not been initiated. After the consultation, the impetigo was treated by empiric antibiotic coverage. The environmental conditions of migrant farmworkers raise special issues for infectious skin diseases like bullous impetigo. Crowded living conditions, lack of proper sanitary facilities, and poor accessibility to health care increase the risk of occurrence and spread of this disease. With the recent emergence of multi-drug-resistant organisms such as methicillin-resistant Staphylococcus aureus in community settings, this case report should serve to reinforce the need to recognize the possibility of infection and to obtain culture specimens at the initial visit to better treat and control this infectious skin condition.