Impetigo

Definition

It is a bacterial skin infection which is highly contagious.¹ It appears as honey crusted sores.²

Age groups affected: It almost exclusively affects pre-school children from 2-5 years.² It spreads by direct contact with someone who has the infection. The bullous type occurs mostly in neonates.¹

Types of Impetigo:

• Bullous Impetigo
• Non- bullous(Impetigo Contagiosa) - Predominant type.

Presentation

Single or multiple erosions along with pustules or blisters with oozing honey-yellow crust are seen.² They often start around the nose and face but can spread by auto-inoculation to the arms and legs. The bullous type is a more serious type and present with multiple bullae (2-5 cms) which are thin-walled and often rupture and scab.² Finding a "collarette" of scale surrounding the ruptured lesion's roof is almost pathognomic of the infection.¹ The diagnosis is mostly clinical rarely requiring culturing to confirm the organism.

Treatment

Impetigo is generally self-resolving in 2 weeks. However, treatment results in a decrease in discomfort improved cosmetic appearance of the lesions and prevention of worrisome consequences.¹ There is no standard treatment and various options are available. Topical antibiotics like fusidic acid, Mupirocin 2% ointment are the best line of treatment.^1,2,4 Oral Erythromycin has shown increased rates of resistance and thus nowadays, either oral azithromycin for 5 days or oral cephalexin for 10 days is the drug of choice.²

There is no evidence supporting the effectiveness of topical disinfectants like chlorhexidine and povidone-iodine.⁴

Complications

Often in cases of streptococcus causing impetigo, there is a risk of developing post-streptococcal glomerulonephritis. This presents with hypertension and hematuria.² Other complications are sepsis, osteomyelitis, arthritis, cellulitis, and staphylococcal skin syndrome.¹ Nasal carriers have been implicated in the recurrence of the disease and should be treated with local mupirocin.²