Youtor
Impetigo
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Impetigo is characterized by erythematous lesions that are covered with a honey-coloured crust. The lesions are usually asymptomatic, but they can be pruritic. • The lesions begin as macules and papules, but then quickly fill with fluid and rupture. Now a distinction is made between the three types of impetigo. In non-bullous impetigo there are small vesicles that quickly burst and often are not present upon evaluation. In bullous impetigo there are large flaccid bullae. In both of these subtypes, the fluid filled lesions rupture and result in a superficial erosion. In the third subtype, ecthyma, the lesions extend into the dermis resulting in ulceration with violaceous borders. • The lesions are highly contagious and can be transmitted to other areas of the body (i.e., autoinoculation) and to other persons. There is often a history of close contact with similar lesions. • A clinical diagnosis can be made based the characteristic skin findings. • Bacterial culture and sensitivity are indicated when there is an outbreak, MRSA is suspected, or if the patient fails to respond to empiric therapy. For those with recalcitrant impetigo, a nasal culture should also be preformed to check for carriage of group A Streptococcus and Staphylococcus aureus. • Topical antibiotics are equal to or more effective than oral antibiotics and are recommended for infections with a limited number of lesions. Although the condition is self-limited, treatment is recommended to prevent the progression of the illness and to prevent the spread of infection to other people. • Disinfecting agents do NOT have proven efficacy and are NOT recommended. • Indications for systemic antibiotics include ecthyma (which can lead to scarring), widespread infection, systemic involvement, and when there is an outbreak. • Children are allowed to return to school following 24 hours of antibiotic therapy. • Poststreptococcal glomerulonephritis is a potential complication of impetigo. It occurs when the pathogenic organism is a nephritogenic strain of group A beta-hemolytic streptococci. Unfortunately it is NOT prevented by antibiotic therapy. • #FOAMped #MedEd #pediatrics • Disclaimer: All the information provided by USMLE Clinic and associated videos are strictly for informational purposes only; it is not intended as a substitute for medical advice from your health care provider or physician. If you think that you or someone that you know may be suffering from a medical condition, then please consult your physician or seek immediate medical attention.
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