Impetigo
IMPETIGO (PYODERMA)
- It is a contiguous, superficial pyogenic infection of skin
- Pyodermas are infection in epidermis, just below the stratum corneum or in hair follicles.
- Two main clinical forms
- Bullous impetigo caused by S. aureus mostly
- Nonbullous impetigo (or impetigo contagiosa or Tilbury Fox) may be caused by Staphylococcus aureus (most common); by group A-beta haemolytic streptococci (mainly in developing nations) or by both.
- Most commonly affects children
- Most common bacterial infection of children
- Occurs in all age including adults and neonates (called pemphigus neonatorum)
- Spread by close contact (contagious).
Bullous impetigo
- Bullae are less rapidly ruptured
- Larger (1-2cm)
- Persist for 2-3 days
- After rupture thin, flat brownish crusts are formed.
Streptococcal impetigo may lead to
- Post streptococcal acute glomerulonephritis (AGN)
- Scarlet fever
- Erythema multiforme
- Rheumatic fever is not a complication of streptococcal impetigo
IMPETIGO CONTAGIOSA
- Caused by Staphylococcus aureus and/or beta hemolytic Streptococci
- It is mostly a disorder of prepubertal children
- Initial lesion is a very thin walled vesicle on an erythematous base which ruptures so rapidly that its seldom seen
- Gradual, irregular, peripheral extension occurs without central healing
- Lesions are usually not painful, heals without scarring, no fever and patient is not ill
Characteristic feature
- Golden or Honey colored crust
- Neutrophils beneath stratum corneum
- Face around nose, mouth and limbs are most commonly affected.
Exam Important
- A 3 year old child is seen by a pediatrician because he has developed multiple isolated lesions on his face and neck. Physical examination reveals many lesions up to 4 cm in diameter with golden crusts, while in other sites small blisters and weeping areas are seen.Impetigo is the most likely diagnosis.
- Impetigo contagiosa may be caused by Staphylococcus aureus (most common) or Group A beta hemolytic streptococci or by both.
- Bullous impetigo caused by S. aureus mostly
- Impetigo may predispose to glomerulonephritis.
- Impetigo does not produce scar on healing.
- Commonest skin infection in children is Impetigo Contagiosa.
- ‘Honey colored’ crusts are characteristic of Impetigo.
- Impetigo is a contagious bacterial infection.
- Impetigo is a pyoderma.
- Treatment for impetigo is Dicloxacillin.
- Pigment production by staphylococcus aureus occurs in Bullous Impetigo.
- Nikolsky’s sign is seen in Bullous Impetigo.
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