Difference between revisions of "Impetigo"
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**Typical causative organisms are ''[[Staphylococcus aureus]] or [[Streptococcus pyogenes]]'' | **Typical causative organisms are ''[[Staphylococcus aureus]] or [[Streptococcus pyogenes]]'' | ||
*Fever and systemic signs are uncommon | *Fever and systemic signs are uncommon | ||
| − | * | + | *[[Post-streptococcal glomerular nephritis]] is a possible complication, and incidence is not reduced by antibiotic therapy |
| + | *Highly contagious and easily transmittable | ||
| − | == | + | ==Clinical Features== |
[[File:ImpetigoF.jpg|thumb|Impetigo honey-colored scab]] | [[File:ImpetigoF.jpg|thumb|Impetigo honey-colored scab]] | ||
| − | *Nonbullous | + | [[File:Impetigo-infected.jpg|thumb|Impetigo on the back of the neck.]] |
| + | [[File:Bullous impetigo1.jpg|thumb|Bullous impetigo after the bulla have broken.]] | ||
| + | *[[rash|Nonbullous]] | ||
**Erythematous macules/papules develop into vesicles which become pustular and rupture | **Erythematous macules/papules develop into vesicles which become pustular and rupture | ||
***As rupture release yellow fluid which dries to form stratified golden crust | ***As rupture release yellow fluid which dries to form stratified golden crust | ||
| − | *Bullous | + | *[[vesiculobullous rashes|Bullous]] |
**Bullae form as result of staph toxin | **Bullae form as result of staph toxin | ||
| − | **Some cases caused by MRSA | + | **Some cases caused by [[MRSA]] |
| + | *Uncommonly painful, but usually pruritic | ||
| + | *Regional [[lymphadenopathy]] is common | ||
| − | == | + | ==Differential Diagnosis== |
| − | + | {{Generalized rash DDX}} | |
| − | |||
| − | |||
| − | |||
| − | |||
| − | == | + | ==Evaluation== |
| − | + | *Clinical diagnosis | |
| − | [[Category: | + | ==Management== |
| + | ===[[Antibiotics]]=== | ||
| + | {{Impetigo Antibiotics}} | ||
| + | |||
| + | ==Disposition== | ||
| + | *Outpatient | ||
| + | |||
| + | ==See Also== | ||
| + | *[[Rash]] | ||
| + | |||
| + | ==References== | ||
| + | <references/> | ||
| + | |||
| + | [[Category:Dermatology]] | ||
[[Category:ID]] | [[Category:ID]] | ||
Latest revision as of 22:49, 27 September 2019
Contents
Background
- Superficial epidermal infection characterized by amber crusts (nonbullous) or vesicles (bullous)
- May be super-infection or primary infection
- Typical causative organisms are Staphylococcus aureus or Streptococcus pyogenes
- Fever and systemic signs are uncommon
- Post-streptococcal glomerular nephritis is a possible complication, and incidence is not reduced by antibiotic therapy
- Highly contagious and easily transmittable
Clinical Features
- Nonbullous
- Erythematous macules/papules develop into vesicles which become pustular and rupture
- As rupture release yellow fluid which dries to form stratified golden crust
- Erythematous macules/papules develop into vesicles which become pustular and rupture
- Bullous
- Bullae form as result of staph toxin
- Some cases caused by MRSA
- Uncommonly painful, but usually pruritic
- Regional lymphadenopathy is common
Differential Diagnosis
Rash
- Acute generalized exanthematous pustulosis
- Allergic reaction
- Aphthous stomatitis
- Atopic dermatitis
- Chickenpox
- Chikungunya
- Coxsackie
- Dermatitis herpetiformis
- Erysipelas
- Exfoliative erythroderma
- Impetigo
- Measles
- Miliaria (Heat Rash)
- Necrotizing fasciitis
- Pellagra
- Poison Oak, Ivy, Sumac
- Psoriasis
- Pityriasis rosea
- Scabies
- Seborrheic dermatitis
- Serum Sickness
- Smallpox
- Shingles
- Tinea capitus
- Tinea corporis
- Vitiligo
Evaluation
- Clinical diagnosis
Management
Antibiotics
Coverage for MSSA, MRSA, Group A Strep
Topical therapy
- Mupirocin (Bactroban) 2% ointment q8hrs x 5 days
- For nonbullous impetigo, topic antibiotics are as effective as oral antibiotics
Oral Therapy
- Cephalexin 500mg (6.25mg/kg) PO q6hrs for 10 days OR
- Amoxicillin/Clavulanate 875mg (12.5mg/kg) PO q12hrs daily x 10 days OR
- Clindamycin 450mg PO q8hrs daily (or 10mg/kg PO q6hrs) for 10 days OR
- Dicloxacillin 500mg (3mg/kg) PO q6hrs daily x 10 days
Disposition
- Outpatient