Referat Makassar • 2016

IMPETIGO
Nurul Rifqiani D. C11112157
Indira Devi F. H. C11112159
Siti Amalia Putri C11112160
Jordy Liong C11112163

Advisors:
dr. Maryam Kusumawaty
dr. Sitti Nur Rahma, Sp.KK.

DEPARTMENT OF DERMATOLOGY AND VENEROLOGY

FACULTY OF MEDICINE • HASANUDDIN UNIVERSITY
Definition

 Impetigo is a superficial skin infection due either to

staphylococci or streptococci, or both.
 Infection in impetigo is confined to the epidermis layer of the
skin.

Gawkrodger, David J. 2003. Dermatology: An Illustrated Colour Text 3rd Edition. UK: Churchill Livingstone. Page 44.
Djuanda, Adhi et al. 2015. Ilmu Penyakit Kulit dan Kelamin Edisi Ketujuh. Jakarta: Badan Penerbit FKUI.
Epidemiology

 Prevalence = 10% of all skin problems seen in general

dermatology clinics.
 Global burden of impetigo = 111 million children (developing
countries) to 140 million people affected at any one time.
 Impetigo occurs both in children (♂ = ♀) and adults (♂ > ♀).
 Bullous form  infants and preschool children
nonbullous form  any age

Mıstık, Selçuk dkk, March 2015, “Bacterial Skin Infections: Epidemiology and LatestResearch”. Turkish Journal of Family
Medicine & Primary Care 2015;9 (2):6574.doi10.5455/tjfmpc.177379.
Bowen, Asha C. dkk, August 2015. “The Global Epidemiology of Impetigo: A Systematic Review of the Population Prevalence
of Impetigo and Pyoderma”. PLOSONEDOI:10.1371/journal.pone.0136789
Predisposing
Factors

 Poor hygiene
 Weakened immune system
 Preexisting injuries to the skin

Djuanda, Adhi et al. 2015. Ilmu Penyakit Kulit dan Kelamin Edisi Ketujuh. Jakarta: Badan Penerbit FKUI.
Etiology

Infection of these bacteria:

 Staphylococcus aureus
 Group A β-hemolytic Streptococcus

Rook, Arthur et al. 2016. Textbook of Dermatology. 9th Edition, Vol 1 Page 664-667, 3015-16.
Pathophysiology

Wolff, Klaus et al. 2008. Fitzpatrick’s Dermatology in General Medicine 8th Edition. USA: McGraw-Hill. 19(2): 2129-2134.
Classification

1. Bullous Impetigo
2. Nonbullous Impetigo (Contagiosa)

Wolff, Klaus et al. 2008. Fitzpatrick’s Dermatology in General Medicine 8th Edition. USA: McGraw-Hill. 19(2): 2129-2134.
Clinical
Manifestations

Bullous Impetigo
History:
 Lesions commonly arise on the
chest, axilla, & back (intertriginous
region).
 Cutaneus lesions: rapid
progression of vesicles to flaccid
bullae (1 to 2 days  rupture &
collaps  light brown to golden
yellow crusts).

Wolff, Klaus et al. 2008. Fitzpatrick’s Dermatology in General Medicine 8th Edition. USA: McGraw-Hill. 19(2): 2129-2134.
Clinical
Manifestations

Nonbullous Impetigo
History:
 Lesions commonly arise on the skin
of the face (especially around the
nares) or extremities after trauma.
 Pruritus or soreness of the area is a
common complaint.
 Cutaneus lesions: vesicle or pustule
 honey-colored crusted plaque &
erythema.

Wolff, Klaus et al. 2008. Fitzpatrick’s Dermatology in General Medicine 8th Edition. USA: McGraw-Hill. 19(2): 2129-2134.
Supporting
Examinations

Laboratory Tests
Gram stain of exudates from bullous impetigo reveals Gram-positive
cocci in clusters.

Histopathology
The lesions of bullous impetigo show vesicle formation in the
subcorneal or granular region, occasional acantholytic cells within the
blister, spongiosis, edema of the papillary dermis, and a mixed
infiltrate of lymphocytes and neutrophils around blood vessels of the
superficial plexus.

Wolff, Klaus et al. 2008. Fitzpatrick’s Dermatology in General Medicine 8th Edition. USA: McGraw-Hill. 19(2): 2129-2134.
Differential
Diagnosis
1. Atopic Dermatitis
 The lesions are characterized by
intensely pruritic, erythematous
papules associated with
excoriation, vesicles over
erythematous skin & crusts.
 There is a history of atopy
(bronchial asthma or allergic
rhinitis).

Djuanda, Adhi et al. 2015. Ilmu Penyakit Kulit dan Kelamin Edisi Ketujuh. Jakarta: Badan Penerbit FKUI.
Differential
Diagnosis

2. Ecthyma
 Ecthyma is a cutaneous
pyoderma characterized by
thickly crusted erosions or
ulcerations.
 Ecthyma occurs most
commonly on the lower
extremities of children or The ulcer has a “punched-out” appearance when
the dirty grayish-yellow crust and purulent material
are debrided
individuals with diabetes.

Wolff, Klaus et al. 2008. Fitzpatrick’s Dermatology in General Medicine 8th Edition. USA: McGraw-Hill. 19(2): 2129-2134.
Treatment

First line therapy Second line therapy

(penicillin allergy)

Topical antibiotics
Mupirocin 2% or Retapamulin 1%
Systemic antibiotics
 Azithromycin 500 mg × 1, then 250
mg daily for 4 days
Systemic antibiotics  Clindamycin 15 mg/kg/day 3x daily
Dicloxacillin 250–500 mg 4x daily for  Erythromycin 250–500 mg 4x daily
5–7 days for 5–7 days

Wolff, Klaus et al. 2008. Fitzpatrick’s Dermatology in General Medicine 8th Edition. USA: McGraw-Hill. 19(2): 2129-2134.
Complications

Impetigo typically isn't dangerous, but sometimes it

may lead to rare but serious complications, including:
 Cellulitis

Wolff, Klaus et al. 2008. Fitzpatrick’s Dermatology in General Medicine 8th Edition. USA: McGraw-Hill. 19(2): 2129-2134.
Rook, Arthur et al. 2016. Textbook of Dermatology. 9th Edition, Vol 1 Page 664-667, 3015-16.
Hartman-Adams, Holly.et al, August 2014. “Impetigo : Diagnosis and Treatment”.American Family Physician.
Complications

 Staphylococcal scalded  Poststreptococcal

skin syndrome glomerulonephritis

Wolff, Klaus et al. 2008. Fitzpatrick’s Dermatology in General Medicine 8th Edition. USA: McGraw-Hill. 19(2): 2129-2134.
Rook, Arthur et al. 2016. Textbook of Dermatology. 9th Edition, Vol 1 Page 664-667, 3015-16.
Hartman-Adams, Holly.et al, August 2014. “Impetigo : Diagnosis and Treatment”.American Family Physician.
Prognosis

 Even without treatment, impetigo usually

heals within 2-3 weeks.
 With appropriate treatment, lession usually
resolve after 7-10 days.
 Untreated or neglected impetigo can progress
to ecthyma.

Wolff, Klaus et al. 2008. Fitzpatrick’s Dermatology in General Medicine 8th Edition. USA: McGraw-Hill. 19(2): 2129-2134.
thankyou
References
1 Wolff, Klaus dkk. 2008. Fitzpatrick’s Dermatology in General Medicine 8th
Edition. USA: McGraw˗Hill.
2 Gawkrodger, David J. 2003. Dermatology: An Illustrated Colour Text 3rd Edition.
UK: Churchill Livingstone.
3 Weller, Richard dkk. 2008. Clinical Dermatology 4th Edition. UK: Blackwell
Publishing.
4 Djuanda, Adhi dkk. 2015. Ilmu Penyakit Kulit dan Kelamin Edisi Ketujuh.
Jakarta: Badan Penerbit FKUI.
5 Bowen, Asha C. dkk, Agustus 2015. “The Global Epidemiology of Impetigo: A
Systematic Review of the Population Prevalence of Impetigo and Pyoderma”.
PLOSONEDOI:10.1371/journal.pone.0136789, 15 September 2016.
6 Mıstık, Selçuk dkk, Maret 2015, “Bacterial Skin Infections: Epidemiology and
LatestResearch”. Turkish Journal of Family Medicine & Primary Care 2015;9
(2):6574.doi10.5455/tjfmpc.177379, 15 September 2016.
References

7 Arthur Rook, D.S. Wilkinson, F.J.G Ebling. 2016. Impetigo.

Textbook of Dermatology. Edisi ke-9, Vol 1 Hal 664-667, 3015-16.
8 Hartman-Adams, Holly. dkk, Agustus 2014 “Impetigo : Diagnosis
and Treatment”. American Family Physician, 14 September 2016.
9 Freedberg , Irwin M. dkk. 2003. Fitzpatrick's Dermatology In
General Medicine 6th edition. By McGraw-Hill Professional.
10 Siregar, R.S, 2005. Atlas Berwama Saripati Penyakit Kulit. Edisi
Kedua. Penerbit Buku Kedokteran EGC. Jakarta. Hal. 45-49.
11 James WD, Berger TG, Elston DM. Andrew's Diseases of The
Skin: Clinical Dermatology 10th edition. Canada.
12 Bolognia Jean, dkk. 2008. Dermatology 2nd Edition. USA: Elsevier.