Impetigo: Difference between revisions
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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 | *[[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== | ==Differential Diagnosis== | ||
{{Generalized rash DDX}} | {{Generalized rash DDX}} | ||
== | ==Evaluation== | ||
*Clinical diagnosis | |||
==Management== | |||
===[[Antibiotics]]=== | ===[[Antibiotics]]=== | ||
{{Impetigo Antibiotics}} | {{Impetigo Antibiotics}} | ||
==Disposition== | |||
*Outpatient | |||
==See Also== | ==See Also== | ||
*[[Rash]] | *[[Rash]] | ||
== | ==References== | ||
<references/> | |||
[[Category: | [[Category:Dermatology]] | ||
[[Category:ID]] | [[Category:ID]] | ||
Latest revision as of 22:49, 27 September 2019
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
Other Rash
- Acute generalized exanthematous pustulosis
- Allergic reaction
- Aphthous stomatitis
- Atopic dermatitis
- Coxsackie
- Dermatitis herpetiformis
- Exfoliative erythroderma
- Impetigo
- Pellagra
- Pityriasis rosea
- Serum Sickness
- 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