Updated: 12/16/2021

Impetigo

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  • Snapshot
    • A4-year-old girl complains of pruritus and a rash on her face for one day. In the next morning her mother notices weeping from the rash and brings her to the pediatrician. She is afebrile. On exam there are multiple vesicles and pustules with overlying honey-colored crust on the chin. There are no bullae. The physician warns that there is a chance that her kidneys may be affected after the infection.
  • Introduction
    • Clinical definition
      • superficial contagious bacterial skin infection which can be divided into
        • nonbullous impetigo (most common) which is
          • caused by Staphylococcus aureus or group A streptococci
        • bullous impetigo
          • caused by Staphylococcus aureus toxin which is a
            • localized form of staphylococcal scalded skin syndrome
  • Epidemiology
    • Incidence
      • 20.5 per 1000 person-years
      • most common bacterial skin infection in children
      • 3rd most common skin disease in children
      • highly contagious
      • 70% of cases are nonbullous impetigo
    • Demographics
      • occurs commonly in children
    • Most common pathogen
      • Staphylococcus aureus
      • group A streptococcus
    • Most common location
      • on face and arms
    • Risk factors
      • summer weather
      • disruption of skin leading to secondary infection of nonbullous impetigo
        • insect bites
        • varicella
        • atopic dermatitis
      • immunocompromise
  • Etiology
    • Pathophysiology
      • superficial skin blister ruptures and forms a crust
      • nonbullous impetigo
        • from host response to infection
      • bullous impetigo
        • caused by staphylococcal toxin
  • Presentation
    • Nonbullous impetigo
      • physcal exam
        • single red macule or papule → vesicle surrounded by erythema → honey-crusted pustules
    • Bullous impetigo
      • physical exam
        • progression from vesicle → flaccid bullae without erythema → crusted erosion
          • ruptured bullae with yellow collarette from crusts
  • Studies
    • Labs
      • positive Gram stain
      • positive superficial wound culture
      • may aid in directing antibiotic therapy
  • Differential
    • Herpes simplex virus
      • vesicles on erythematous base (bullous impetigo typically has no erythema)
    • Pemphigus foliaceus
      • erythema with scaling and crusting
  • Treatment
    • Medical
      • topical antibiotics
        • indication
          • local involvement of disease
        • medications
          • mupirocin, retapamulin, or fusidic acid
      • oral antibiotics
        • indication
          • widespread involvement of disease
        • medications
          • empiric treatment with cephalexin
  • Complications
    • Spread to other members of the family
      • impetigo is highly contagious
      • cover open skin lesions
    • Acute post-streptococcal glomerulonephritis
      • 1-5% of patients with nonbullous impetigo
  • Prognosis
    • survival with treatment
      • very good
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(M2.DM.15.4677) A 3-year boy with a history of atopic dermatitis is brought to his pediatrician for onset of a new facial rash. His skin exam (Figure A) is notable for erythematous erosions on his cheeks and surrounding his nares, some with an overlying honey-colored crust. What is the optimal first-line treatment for these lesions?

QID: 107241
FIGURES:
1

Topical hydrocortisone 0.1%

17%

(2/12)

2

Topical mupirocin

58%

(7/12)

3

Oral trimethoprim-sulfamethoxazole

0%

(0/12)

4

Oral penicillin

25%

(3/12)

5

Oral dicloxacillin

0%

(0/12)

M 7 E

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