Latest Treatment of Impetigo
Bullous impetigo, or staphylococcal impetigo, is a local skin infection caused by phage group II staphylococci. The staphylococci produce an epidermolytic toxin that acts locally to cause separation of the skin at the granular layer, giving rise to bullae. The infection occurs primarily in newborn infants and young children. The characteristic skin lesions of bullous impetigo are superficial, flaccid, thin-walled bullae that occur most often on the extremities but can occur anywhere. They range in size from 0.5 to 3 cm. They can arise from normal skin or may have a thin, red halo. The bullae are filled with a clear, pale-to-yellow fluid and rupture easily, leaving a moist, denuded base that dries rapidly with a shiny coating. Extensive areas of skin may be involved if untreated.
Impetigo is a superficial pyoderma caused by infection with staphylococci, although group A b-hemolytic streptococci may also be cultured. It is a common skin infection, primarily affecting young children, especially in warm, humid conditions. Impetigo can arise at the site of insect bites or superficial cutaneous trauma sometimes there is no apparent predisposing skin lesion. Fever and systemic signs are uncommon. FIG. 131-1. Impetigo contagiosum. From Marples RR, Leyden JL Bacterial infections, section I. Fundamental cutaneous microbiology, in Moschella SL, Hurley HJ The diagnosis of impetigo can be readily made on the basis of the typical clinical appearance. Cultures are generally not necessary. Systemic antibiotic therapy must be combined with wound scrubbing and cleansing and application of neosporin or mupirocin ointment for optimal results. Effective antibiotics include oral antibiotics such as erythromycin, clindamycin, cephalosporins, and dicloxacillin.
The majority of 'classic' skin and soft tissue infections are due to extracellular bacteria and are characterized by the presence of a polymorphonuclear inflammatory response. Impetigo, ecthyma, erysip- Impetigo results from a superficial infection of skin, usually by group A streptococci or Staphylococcus aureus. Infectious manifestations begin with formation of thin-roofed vesicles that rapidly pustulate and rupture. Dried, purulent discharge results in the formation of a characteristic, adherent, golden-brown crust. The vesico-pustule forms between the stratum corneum and the stratum granulosum, and the inflammatory response is predominately polymorphonuclear in nature. The most serious complication is that of streptococcus-specific antibody-as-sociated glomerulonephritis that can occur approximately 2 weeks after the cutaneous infection. Bullous impetigo also results from a superficial infection of skin but is caused by locally invasive phage-group 2 S. aureus that produces a...
The chief complaint of children with impetigo is most often that of sores on the body. There are no associated systemic manifestations such as fever or malaise. Regional lymph nodes may be minimally enlarged. The typical lesion of impetigo contagiosa begins as an erythematous papule. Small vesicles may follow transiently, but rapid progression to crusted lesions occurs. These crusts, which are initially honey-colored and fine in consistency, may appear on any area of the body between the upper lip and the nose is a very characteristic site. The lesions enlarge over days to weeks, and the crusts become thicker. Erythema is mild. No induration is present. In bullous impetigo, the characteristic skin lesions are superficial bullae filled with purulent material. The bullae range in size from 0.5 to 3 cm and have minimal, if any, surrounding erythema.
The cells of staphylococci occur in irregular bunches rather than ordered chains. They also produce lactic acid but can additionally carry out aerobic respiration involving cytochromes, and lack the complex nutritional requirements of the lactic acid bacteria. They are resistant to drying and able to tolerate relatively high concentrations of salt. These properties allow Staphylococcus aureus to be a normal inhabitant of the human skin, where it can sometimes give rise to dermatological conditions such as acne, boils and impetigo. It is also found in the respiratory tract of many healthy individuals, to whom it poses no threat, but in people whose immune system has been in some way compromised, it can cause serious respiratory infections. S. aureus can also cause a type of food poisoning and is the causative agent of toxic shock syndrome. Widespread antibiotic use has been largely responsible for the development of resistant forms of S. aureus, which have become ubiquitous inhabitants...
Impetigo There are two major forms of the disease Bullous impetigo and impetigo contagiosum (the latter being referred to most commonly as just impetigo ). Bullous impetigo is caused by staphylococci that produce an epidermolytic toxin. Impetigo (contagiosum) results from an infection of staphylococci or group A -hemolytic streptococci.
Dermatologic findings are common in zoonotic infections, as the dermis is often the site of inoculation and may display focal findings. The common dermatologic infections of impetigo, ecthyma, and cellulitis can be transmitted zoonotically, as can human infestations with mites and lice. The dermatophytoses Tinea verrucosum and Microsporum canis account for the majority of zoonotic dermatophyte infections, with M. canis accounting for 15 percent of all human dermatophytoses.51 Chancriform lesions (ulcerations at the site of inoculation) can result from zoonotic infection of bacterial, mycobacterial, fungal, or viral etiology. The most significant bacterial chancriform zoonotic lesions are Bacillus anthracis (anthrax), Bartonella henselae (cat-scratch disease), Erysipelothrix rhusiopathiae (erysipeloid), Francisella tularensis (tularemia), Listeria monocytogenes (listeriosis), Mycobacterium marinum, and Pseudomonas mallei (glanders).5,3052 The vast majority of these chancriform zoonotic...
A number of infectious syndromes caused by toxigenic bacteria with toxin-mediated dermatologic manifestations have been described, including toxic shock syndrome (TSS), streptococcal toxic shock syndrome (STSS), SSSS, bullous impetigo, and scarlet fever. In certain cases, the bacteria are colonizers with the disease resulting only from the toxin (e.g., TSS) in other instances, the toxigenic organism produces infection with clinical manifestations developing from both the infectious process and the presence of the toxin (e.g., STSS, SSSS, bullous impetigo, and scarlet fever).
Impetigo Definition This chapter discusses several of the more common skin and soft tissue infections of childhood, including conjunctivitis, impetigo, sinusitis, and cellulitis. Because of its particular severity, orbital periorbital cellulitis will be highlighted in a section separate from the general discussion of cellulitis however, the pathophysiology and clinical manifestations that are shared will not be repeated.
An episode of SSSS frequently begins as a clinically inapparent staphylococcal infection of the conjunctiva, nasopharynx, or umbilicus. The disease course can be divided into three phases initial erythroderma exfoliative and desquamation recovery. Initially, the patient (or parent) notes the sudden appearance of a tender erythroderma, usually diffuse, although localized disease has been described. The involved skin may have a sandpaper texture. Tender erythema is prominent in the perioral, periorbital, and groin regions, as well as in the skin creases of the neck, axilla, popliteal, and antecubital areas. The mucous membranes are spared. The exfoliative stage begins on the second day of the illness. The erythematous skin wrinkles and peels off at sites of minor trauma or with minimal lateral pressure with the examiner's fingertip, illustrating the positive Nikolsky's sign (also found in TEN). Large, flaccid, fluid-filled bullae and vesicles then appear. These lesions easily rupture...
In addition to the infections mentioned above, numerous other infections can occur on the face. In children, impetigo on the face is common, as is dermatophyte infections (tinea faciei and tinea barbae). Staphylococcal folliculitis is also seen on the face. The face and scalp are also a common site of involvement in secondary syphilis in which individuals develop moth-eaten alopecia, scaly or moist papules around the nose and at the angles of the mouth. Flat warts are frequently seen in males as a result of spreading the virus by shaving. Numerous molluscum contagiosum on the face of an adolescent or adult are suggestive of HIV. Patients with this disorder should be tested for HIV.
Generalized cutaneous conditions, such as xerosis (dry skin), seborrheic eczema, and pruritus, are common and may be manifested prior to development of opportunistic infections. Treatment is with emollients and, if necessary, mild topical steroids. Pruritus may respond to oatmeal baths and antihistamines. Other infections, including S. aureus (manifested as bullous impetigo, ecthyma, or folliculitis), Pseudomonas aeruginosa (which may present with chronic ulcerations and macerations), and syphilis are frequently seen and should be treated with standard therapies. Several specific dermatologic conditions are discussed in more detail below.
The search strategy Psoria* or Acrodermatitis continua of Hallopeau or (Impetigo and herpetiformis) or ((Palm* or Plant* or Sole* or Bacterid) and (Pustul* or Psoria*)) or Acropustulosis was used to search the Cochrane Central Register of Controlled Trials (Issue 3, 2001) and the European Dermato-Epidemiology Network (EDEN) database of psoriasis trials, and filtered using the Cochrane optimal search strategy for randomised controlled trials (RCTs),10 Medline and Embase (both to August 2001). The results were crosschecked against the Salford Database of Psoriasis Trials developed for the systematic review published in 2000.11
Impetigo is a superficial bacterial infection of the skin confined to the epidermis. Deeper spread to the dermis leads to ecthyma. There are two varieties of impetigo impetigo contagiosa and bullous impetigo. Etiology Traditionally, group A b-hemolytic streptococcus (GABHS) was considered the major pathogen in impetigo contagiosa. However, recent studies have suggested that Staphylococcus aureus often can be the primary infecting agent and that therapy which does not include coverage for this organism is significantly less effective. In particular, in bullous impetigo, the primary pathogen is S. aureus
Burns constitute another form of inflicted injuries.33 These may be scald burns caused by immersion in hot water. Such burns do not conform to a splash configuration rather, an entire hand or foot ( glove-and-stocking pattern) may be involved. There is sharp demarcation of the burn margin. The buttocks may be burned during toilet-training punishment by immersion in a bathtub filled with hot water. Knees, anterior thighs, feet, and portions of the abdomen are spared, and the buttocks and genitalia are scalded. Cigarette burns leave small (approximately 5 mm) circumferential scab-covered injuries. These lesions may resemble impetigo, as do scald injuries, which may resemble bullous impetigo. A culture of material from these lesions differentiates the burn from the infection. Other inflicted burns can result from forced contact with metal objects, such as an iron, curling iron, or heater grid.
Topical antibacterial agents are used primarily as adjuncts to wound dressings these agents rarely are useful as primary therapy for superficial bacterial infections of the skin. The exception to this statement is topical mupirocin, which is reportedly as effective as oral antimicrobial agents in the management of impetigo. Concerning wound dressings, the agents commonly used include polymyxin B, bacitracin, neomycin, and silver sulfadiazine. Suggested benefits of these medications include reduced adherence of bandaging material to the wound, as well as less coagulum and decreased bacterial colonization. The impact on the rate of wound healing and the prevention of wound infection are less well characterized. Another use of topical antibacterial agents is the treatment of aphthous stomatitis with oral tetracycline rinses. Systemic antibiotic therapy is of use in certain dermatologic syndromes and is discussed in those areas.
The main concern in the treatment of flea bites is the possibility of secondary infection. Children may develop impetigo as a complication. The lesions should be washed thoroughly with soap and water. Children with flea bites should have their fingernails cut short to prevent scratching. To relieve discomfort and itching, starch baths at bedtime (about 1 kg starch to a tubful of water), local application of calamine, cool soaks, and oral antihistamines may be helpful. For severe discomfort, application of a topical steroid cream or spray may be necessary. If secondary infection develops, topical or oral antibiotics may be needed.
Basic vaccination programs for goats include vaccinations against Clostriduim perfringens types C and D and Clostridium tetani. 1'3'6 There are multivalent clostridial vaccines, including those against black leg, malignant edema, and bacillary hemoglobinuria, used in goats. These are unusual diseases in goats, and vaccination to prevent them is usually not economically justified. Vaccines against contagious ecthyma, caseous lymphadenitis, and Chlamydia are incorporated in the vaccination program if there is a need in that particular herd. 1-3,5