Impetigo

Notes

## Basic introduction

  • Impetigo is a highly contagious skin infection that most commonly affects children
  • There are three types of impetigo:

_Bullous impetigo

_Non-bullous impetigo or impetigo contagiosa (70% of all cases)

_Secondary impetiginization superimposed on another primary dermatitis

  • Impetigo is more prevalent in:

_Children aged 2-5 years (but it can affect adults as well)

_People living in confined environments (such as army barracks, prisons, and schools)

_Warm and humid climates

_Conditions where there is poor hygiene

_Cases where the skin barrier is broken such as:

 ||| Scabies

 ||| Eczema

 ||| Insect bites

 ||| Mycosis

 ||| Trauma

 ||| Purpura urticaria

_Pre-existing diseases/situations such as:

 ||| Diabetes mellitus

 ||| HIV

 ||| Tumors

 ||| Chemotherapy

 ||| IV drug users

  • Causes of impetigo are:

_Staphylococcus aureus

_Streptococcus pyogenes

(Infections occur mainly after the damage of the skin)

## Statistics

  • Median childhood prevalence of impetigo and pyoderma globally is 12·3%d

## Complication of impetigo

  • Bacteremia or sepsis
  • Cellulitis
  • Guttate psoriasis
  • Post-streptococcal glomerulonephritis
  • Scarlet fever
Symptoms

## Bullous impetigo

  • Fever
  • Lymphadenopathy
  • Mainly affects babies and children < 2yrs
  • Fluid-filled blisters appear on the trunk, legs, and arms
  • The skin around the blister is red and itchy but lacks sore
  • The blisters burst, leaving a yellow crust
  • The crust mainly heals with no scarring
  • Blisters are normally painless with some itching

## Non-bullous impetigo

  • Fever
  • Lymphadenopathy
  • Red sores appear around the mouth and nose
  • The sores burst
  • Yellowish-brownish golden crusts
  • Normally heals without any scarring
  • Blisters are normally painless with some itching
Diagnosis
  • Clinical review
  • Swab, culture, and sensitivity test
Prevention
  • Maintaining good hygiene
  • Prompt treatment of skin lesions
Reference

1. Brown, J., Shriner, D. L., Schwartz, R. A., & Janniger, C. K. (2003). Impetigo: an update. International journal of dermatology, 42(4), 251-255.

2. Kenyan Ministry of Health. Clinical guidelines for management and referral of common conditions at levels 4-6. Hospitals. 2009; 3:259-261.http://apps.who.int/medicinedocs/documents/s21000en/s21000en.pdf

3. Ministry of Health, Kenya. Kenya Essential Medicine List (2016). http://publications.universalhealth2030.org/uploads/KEML-2016Final-1.pdf

4. Bowen, A. C., Mahé, A., Hay, R. J., Andrews, R. M., Steer, A. C., Tong, S. Y., & Carapetis, J. R. (2015). The global epidemiology of impetigo: a systematic review of the population prevalence of impetigo and pyoderma. PloS one, 10(8), e0136789.

Management
  • Cleaning with saline water
  • Topical antibacterial

_Oint Mupirocin 2% TID x 1/52

_Oint Fucidic acid 2% TID x 7/7 to 12/7

_Recurrent impetigo may be caused by chronic S. aureus colonization of:

||| Nasal vestibule

||| Perineum

||| Axillae

This is treated with

_Oint Mupirocin 2% QID x 1/52

  • Oral antibiotics:

 Either;

_For children:

Flucloxacillin:12.5mg/kg/dose, QID x 5/7 (maximum 500 mg/dose)

_For adults:

Flucloxacillin 500mg QID x 5/7

 Or;

_For adults:

Tabs Erythromycin 250mg QID x 5/7

Or;

_For adults (and those > 40kg):

Tabs Amoxicillin/clavulanic acid 1gm BD x 1/52

_For children < 3 Mo:

Susp Amoxicillin/clavulanic acid 30mg/kg/day x 1/52

_For children >3 Mo but < 40kg:

Susp Amoxicillin/clavulanic acid 25-45mg/kg/day x 1/52

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