Impetigo

O Impetigo is a skin infection that most commonly afflicts young children. It is caused by group A streptococci or Staphylococcus aureus and is characterized by the development of numerous blisters that rupture and form crusts. Dicloxacillin, cephalexin, and topical mupirocin are considered the antibiotics of choice for treatment of impetigo. 

The primary goal of therapy for impetigo is resolution of infection. A secondary goal is prevention of glomerulonephritis (although extremely rare) secondary to group A Streptococcus (GAS). 

Because impetigo is rarely painful, there is often a delay in seeking medical attention. However, the lesions will resolve with time and increased hygiene. Soaking the lesions with soap and water and the use of skin emollients to dry skin areas may reduce spread of the lesions. 

Because GAS historically has been the primary causative organism, penicillin has been the mainstay of therapy. O However, the incidence ofS. aureus impetigo is increasing, so oral penicillinase-stable penicillins or first-generation cephalosporins are now preferred.3 Erythromycin is an alternative choice when penicillin allergy is a concern. Topical mupirocin may be used alone when there are few lesions.3... 

Bacterial infections of the skin can be classified as primary or secondary (Table 47-1). Primary bacterial infections are usually caused by a single bacterial species and involve areas of generally healthy skin (e.g., impetigo, erysipelas). Secondary infections, however, develop in areas of previously damaged skin and are frequently polymicrobic. 

Impetigo is a superficial skin infection that is seen most commonly in children. It is highly communicable and spreads through close contact. Most cases are caused by S. pyogenes, but S. aureus either alone or in combination with S. pyogenes has emerged as a principal cause of impetigo. 

Exposed skin, especially the face, is the most common site for impetigo. 

Weakness, fever, and diarrhea are sometimes seen with bullous impetigo. 

Nonbullous impetigo manifests initially as small, fluid-filled vesicles. These lesions rapidly develop into pus-filled blisters that readily rupture. Purulent discharge from the lesions dries to form golden yellow crusts that are characteristic of impetigo. 

In the bullous form of impetigo, the lesions begin as vesicles and turn into bullae containing clear yellow fluid. Bullae soon rupture, forming thin, light brown crusts. 

Potassium permanganate (KMnO ) is a purplish crystal-like oxidizing compound used as an antiseptic and disinfectant to inhibit the growth of harmful skin microorganisms and bacteria. Before antibiotics were available, it was used as a treatment for trench mouth and impetigo. 

Impetigo is a skin infection that usually occurs in young children living in unsanitary conditions in warm climates. It is caused either by Streptococcus or Staphylococcus bacteria or both together. It produces a tan scab that may disappear in about 10 days, and should be treated with an antibiotic because it is contagious and can cause kidney damage. 

Antibacterial treatment is generally not required in cases of gastroenteritis. Typhoid fever is treated with ciprofloxacin (quinolone), cefotaxime (third generation cephalosporin) or chloramphenicol. Impetigo necessitates the systemic use of flucloxacillin or erythromycin. Topical fusidic acid or mupirocin may also be used. 

Q83 Patients using Elidel cream should be advised to avoid alcoholic drink during treatment. Elidel may cause folliculitis and impetigo as side-effects. 

Elidel cream consists of pimecrolimus, which is a calcineurin inhibitor that is used for eczema or psoriasis. Patients should be advised to avoid alcoholic drink during the treatment period as consumption of alcohol may lead to facial flushing and skin irritation. Side-effects associated with the topical administration of pimecrolimus include a burning sensation, pruritus, erythema and skin infections, including folliculitis and, less commonly, impetigo. 

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