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Impetigo is a superficial infection of the skin by Staphylococcus aureus and/or Streptococcus pyogenes bacteria. There are two forms of impetigo: bullous, and superficial or common. Bullous impetigo is caused by Staphylococcus aureus and is characterized by thin-walled blisters that rupture and develop a thin, varnish-like crust. Superficial or common impetigo is caused by Streptococcus pyogenes alone or in combination with Staphylococcus aureus and is characterized by thick, adherent, yellow crusts with a red border. The most likely regions to be affected are the face, scalp, and extremities. Impetigo at a deeper level of skin, usually in an unexposed area (the legs), is called ecthyma.
Risk: Risk factors include poor hygiene and overcrowded environments. Impetigo affects primarily children and adolescents. Incidence and Prevalence: In pediatric clinics, impetigo accounts for 10% of all presenting skin problems in the US (Lewis). Impetigo is more common in warm, humid climates. Internationally, impetigo occurs most frequently at lower altitudes, in tropical climates. |
Source: Medical Disability Advisor
| History: The individual may complain of an itchy, rapidly spreading rash or fluid-filled blisters. There may be a history of a minor breach in skin integrity, such as a cut, insect bite, or herpes outbreak. Physical exam: Individuals with common (superficial) impetigo have the typical small, multiple, red-rimmed collections of pus (pustules) with adherent dirty-yellow-colored crust. Large, fluid-filled blisters that leave a thin crust are present in individuals suffering from bullous impetigo. Some individuals may present with both types of lesions. Nearby lymph nodes may be swollen. The affected region may have evidence of pre-existing scabies, eczema, herpes, or lice infestation (pediculosis). Tests: A microscopic examination (Gram stain) of a sample of the pus will confirm the infection. Bacterial cultures and antibiotic sensitivity testing may be performed. |
Source: Medical Disability Advisor
| Topical or systemic antibiotics are used to treat this infection. The crusts may be gently removed after soaking the affected area in a warm antiseptic solution. Frequent application of wet dressings to affected areas is recommended. |
Source: Medical Disability Advisor
| Impetigo is easily treated with antibiotics and has an excellent prognosis. Left untreated, impetigo should spontaneously resolve in time. |
Source: Medical Disability Advisor
| Deeper infection of the skin is possible, forming a boil. Impetigo involving Staphylococcus aureus may progress to staphylococcal scalded skin syndrome, characterized by large sheets of peeling skin. However, this syndrome is rarely seen in individuals over the age of 12 years. In rare cases, Streptococcus infection can result in acute kidney disease (glomerulonephritis), scarlet fever, hives (urticaria), and erythema multiforme. |
Source: Medical Disability Advisor
| Because impetigo is highly contagious, the individual should avoid direct contact with others until the infection has cleared. Maintaining moderate ambient temperature and humidity in the workplace can help to reduce future infection. Healthcare workers and childcare personnel may need to be off work until lesions clear. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Does individual have signs of impetigo, such as blisters or lesions with thick yellow crusts and red borders?
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Are lesions located on the face, scalp, and/or extremities?
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Has there been a history of insect bites, herpes, or skin lacerations?
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Are physical findings consistent with the diagnosis of impetigo?
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Did a Gram stain or culture identify the presence of Staphylococcus aureus or Streptococcus pyogenes?
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Have other conditions with similar symptoms been ruled out in the differential diagnosis?
Regarding treatment:
- Has the causative bacteria been subject to sensitivity testing to confirm that the appropriate antibiotic treatment was undertaken?
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If symptoms persisted following antibiotic treatment, were lesions recultured to determine if bacteria are resistant to current antibiotic therapy?
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Has antibiotic been changed?
Regarding prognosis:
- Has individual had this infection before?
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Does individual have an underlying condition that may affect ability to recover?
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Did individual complete the entire course of antibiotic?
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Source: Medical Disability Advisor
| Lewis, Lisa S., and Allan D. Friedman. "Impetigo." eMedicine. Eds. Glenn Fennelly, et al. 24 Aug. 2004. Medscape. 8 Oct. 2004 <http://emedicine.com/ped/topic1172.htm>. |
Source: Medical Disability Advisor