Impetigo

Impetigo is a common superficial bacterial infection of skin caused most often by S. aureus and in some cases by group A -hemolytic streptococci. Lesions caused by staphylococci may be tense, clear bullae, and this less common form of the disease is called bullous impetigo.

Signs and symptoms

Symptoms include red, itchy sores that break open and leak a clear fluid or pus for a few days. Next, a crusty yellow or “honey-colored” scab forms over the sore, which then heals without leaving a scar.

Children with nonbullous impetigo commonly have multiple coalescing lesions on their face (perioral, perinasal) and extremities or in areas with a break in the natural skin defense barrier.

The initial lesions are small vesicles or pustules (< 2 cm) that rupture and become a honey-colored crust with a moist erythematous base.

Pharyngitis is absent, but mild regional lymphadenopathy is commonly present.

Nonbullous impetigo is usually a self-limited process that resolves within 2 weeks.

with systemic symptoms such as fever, malaise, generalized weakness, and diarrhea.

Diagnosis

The diagnosis of impetigo is usually made on the basis of the history and physical examination.

Management

• Encourage patients to avoid aggravating factors, maintain a balanced diet, and control stress.
• Patients should wash no more than twice daily with a mild, nonfragranced opaque or glycerin soap or a soapless cleanser. Scrubbing should be minimized to prevent follicular rupture.
• Comedone extraction results in immediate cosmetic improvement but has not been widely tested in clinical trials.

Mild disease

(Localized non bullous impetigo ( less than 5 lesions in a single skin area )

• Clean with soap and water and dry it.
• Keep fingernails short.
• Avoid touching the lesions, keep them covered with gauze if possible.
• Apply Mupir / Bactoderm ( Mupirocin 2 % ) ointment 3 times per day for 7 days.
• Reassess after 3 days. If there is no response , switch to oral antibiotic therapy ( see below ).

Severe Disease

(Extensive non bullous impetigo ( more than 5 lesions or impetigo involving more than one skin area ) , bullous impetigo , ecthyma , impetigo with abscess ; immunocompromised patient ; topical treatment failure )Incise abscesses if present. Add oral antibiotics to mild disease therapy

• Cap - Biflocin ( amoxicillin + flocloxacillin ) 500mg , 1 cap TDS for 7 days in adults
• Syp - Biflocin ( amoxicillin + flocloxacillin ) 125-250mg / 5ml , 1TSF PO x BD for 7 days in children.In penicillin - allergic patients only ( resistance to macrolide s is common ) : use
• Tab - Erythrocin ( erythromycin ) 500mg - 1gm PO x TDS for 7 days ( children : 30 to 50 mg / kg / day in 2 or 3 dd ) ' OR '
• Tab - Ecasil / Nezkil (Linezolid) 600mg , 1 tab PO x BD for 7 days in adults
• Syp- Ecasil / Nezkil (Linezolid) 100mg / 5ml, 1TSF PO x BD for 7 days in children.Note : in newborns with lesions located around the umbilicus , administer cloxacilllin IV.
• Quarantine children from school (They can return to school after 24 to 48 hours of antibiotic therapy)
• Look and treat for any underlying dermatoses: lice, scables, eczema, herpes, scalp ringworm, or an ENT infection.
• Trace and treat contacts
• Check for proteinuria (use urine dipstick) 3 weeks after the infection