IMPETIGO:

Impetigo is a superficial skin infection that normally affects children. It is contagious and spreads via
person -to-person contact. There are 2 variants: non bullous and bullous impetigo.

A 2 year old male with a background history of atopic dermatitis presents with honey comb
crusted plaques on the face

Crusted plaque

1. Non-bullous impetigo:

Caused by Staphylococcus aureus and occasionally β-hemolytic Streptococcus.

Presents as pustules or papules that develops into thin-roofed vesicles. The vesicles rupture easily
and forms a honey-coloured crust. Common sites are the face, around the nose and mouth and the
extremities.

Lesions are spread by autoinoculation.

.A 3 year old male presented with fever and flaccid vesicles and bullae that later developed a
collarette of scale on the neck and trunk

Flaccid bullae

Collarette of scale

2. Bullous impetigo

Caused by Staphylococcus aureus which produces exfoliatin toxin resulting in bullous formation.

Presents as flaccid, thin-walled tender bullae. A collarette of scale is noted when the bullae are
deroofed. Common sites are the napkin area, face and extremities.

This variant is a localised form of staphylococcal scalded skin syndrome

Predisposing factors for impetigo

- Poor hygiene

- Atopic diathesis

- Skin trauma

- Humidity, warm temperature

Nasal, perianal and pharyngeal colonization with Staph aureus is a risk factor for developing this
infection

Complications of impetigo:

• Sepsis
• Pneumonia
• Septic arthritis
• Streptococcal complications – Glomerulonephritis, guttate psoriasis
Differential diagnosis

Non bullous impetigo:

- Eczema
- Tinea corporis
- Insect bites
- scabies

Bullous impetigo

- bullous insect bites

- herpes simplex infection
- stevens Johnson syndrome

Management:

Limited disease:

• Topical antibiotics to the lesions– mupirocin, fusidic acid

• Nasal mupirocin to decrease staphylococcal carriage

Extensive disease:

• Topical therapy above

• Oral antibiotics or intravenous antibiotics if systemically unwell
-Cephalexin
-Flucloxacillin
• Nasal mupirocin – apply at night for a week to decrease staphylococcal carriage
• Bleach baths or chlorhexidine baths to decrease staphylococcal carriage