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Updated: Apr 7 2017


  • Snapshot
    • A 10-day-old girl is brought to the pediatrician by her mother after noticing multiple blisters. The mother states that some of the blisters have ruptured and left behind a ring of crust. On physical examination there is two 3 cm lesions on her axillae and several smaller bullae without any erythema in the groin. A superficial wound culture grows Staphylococcus aureus. She is subsequently started on topical antibiotics.
  • Introduction
    • Clinical definition
      • superficial contagious bacterial skin infection which can be divided into
        • nonbullous impetigo (most common) which is
          • caused by Staphylococcus aureus or group A streptococci
        • bullous impetigo
          • caused by Staphylococcus aureus toxin which is a
            • localized form of staphylococcal scalded skin syndrome
    • Epidemiology
      • incidence
        • 20.5 per 1000 person-years
        • most common bacterial skin infection in children
      • demographics
        • occurs commonly in children
      • most common pathogen
        • Staphylococcus aureus
        • group A streptococcus
      • most common location
        • on face and arms
      • risk factors
        • summer weather
        • disruption of skin leading to secondary infection of nonbullous impetigo
          • atopic dermatitis
    • Pathophysiology
      • superficial skin blister ruptures and forms a crust
    • Prognosis
      • survival with treatment
        • very good
  • Presentation
    • Nonbullous impetigo
      • physcal exam
        • single red macule or papule → vesicle surrounded by erythema → honey-crusted pustules
    • Bullous impetigo
      • physical exam
        • progression from vesicle → flaccid bullae without erythema → crusted erosion
          • ruptured bullae with yellow collarette from crusts
  • Studies
    • Labs
      • positive Gram stain
      • positive superficial wound culture
  • Differential
    • Herpes simplex virus
      • vesicles on erythematous base (bullous impetigo typically has no erythema)
    • Pemphigus foliaceus
      • erythema with scaling and crusting
  • Treatment
    • Medical
      • topical antibiotics
        • indications
          • local involvement of disease
      • oral antibiotics
        • indications
          • widespread involvement of disease
  • Complications
    • Spread to other members of the family
      • impetigo is highly contagious
      • cover open skin lesions
    • Acute post-streptococcal glomerulonephritis
      • 1-5% of patients with nonbullous impetigo
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