Impetigo

Question 1

What is impetigo

Answer 1

Superficial bacterial skin infection

Question 2

What bacteria cause impetigo

Answer 2

Staphylococcus aureus mainly but can also be caused by Streptococcus pyogenes
Contagious

Question 3

Impetigo presentation

Answer 3

Infant or child presents with itchy skin lesions (bullous or non-bullous) on the face or extremities
May have a fever
Golden crust is typical in Staph infection

Question 4

Impetigo differentials

Answer 4

Cellulitis, Necrotising fasciitis, Candidiasis, Tinea capitis or corporals, scabies, Herpes simplex, Dermatitis

Question 5

Non-bullous impetigo vs bullous impetigo

Answer 5

Non-bullous typically around nose or mouth. Exudate from lesions dries to form a golden crust - often don’t cause systemic symptoms

Bullous impetigo is always caused by Staph aureus - can produce epidermolytic toxins that break down proteins that hold skin cells together. Causes 1-2cm fluid filled vesicles to form on skin. Grow in size then burst forming a golden crust. Lesions can be painful and itchy. More common in children <2yrs and may have systemic symptoms e.g. fever and feeling unwell.

Question 6

Name for severe impetigo infection with widespread lesions

Answer 6

Staphylococcus scalded skin syndrome

Question 7

Impetigo complications

Answer 7

Cellulitis if infections gets deeper into skin
Sepsis
Scarring
Post streptococcal glomerulonephritis 
Staphylococcus scalded skin syndrome
Scarlet fever

Question 8

Impetigo causes

Answer 8

When bacteria enter via a break in the skin. May be in healthy skin or may be related to eczema or dermatitis

Question 9

Impetigo management

Answer 9

Don’t touch or scratch, hand hygiene and avoid sharing towels or cutlery.
Off school until lesions have healed or been treated with ABX for at least 48 hrs.
Non-bullous:
1st line - Antiseptic cream (1% hydrogen peroxide)
Then try topical fusidic acid (ABX)
More widespread = oral flucloxacillin
Bullous:
Oral flucloxacillin