Impetigo Flashcards
describe pustule
opaque coulour inside
-ex. pustules
describe vesicles
cold sore
define bullae
raised lesion with defined edge
surrounding skin may be red, dpnds on cause
what is the more common form of impetigo
non-bollous impetigo
Non-bullous impetigo
- presentation
- progression of dermatological condition/ time frame
- where found on body
- symptoms
PRESENTATION
- clusters of vesicles with red surrounding skin
PROGRESSION
- vesivles –> pustules –> rupture –> fluid dries to thick, honey-coloured crust
(~1wk)
WHERE
- usually on face or extremities
SYMPTOMS
- may be itchy or tender, often with local lymphadenopathy
bullous Impetigo
- how common rel NBI
- presentation
- progression
- where
- symptoms
COMMON?
-less common
PRESENTATION
- large bullae, normal surrounding skin
progression
-rupture –> fluid dries to thin paper-like brown crust
WHERE
- usually on trunk, extremities, intertriginous areas
SYMPTOMS
- more painful than NBI, more likely have systemic features
Impetigo resolution
usually resolve on its own ( 2-4 wks) without scarring
hypo/hyper- pigmentation possible
impetigo complications
RARE
-ex. cellulitis
Pathophysiology of Impetigo
break in the skin allows skin colonizing bacteria to penetrate
what skin colonizing bacteria can cause impetigo
- where found
group A streptococcus
staphylococcus aureus
found in warm moist places
what bacteria causes skin bullous form impetigo
toxin producing strains of S.aureus
Risk factors for skin colonizing bacteria (4)
crowding
poor hygiene
season (summer and fall)
infants (bullous) and preschool children (NBI)
risk factors due to broken skin (3)
burns
scrapes and cuts
anything that causes scratching
(7) Red flags for referral of impetigo
- fever
- malaise
- significant pain
- immunocompromise
- extensive skin involvement (2-3 patches) (widespread erythema suggestive of cellulitis)
- recurrent episodes
- suspected bullous impetigo
what qualifies as extensive skin involvement (2)
more than 2 or 3 small patches
widespread erythema suggestive of cellulitis
what does episodes of impetigo warrant (other than referral, done by doctor)
may require additional diagnostics +/- S.aureus decolonization
GoT for mild uncomplicated non-bullous impetigo (4)
1) cure infection
2) reduce symptoms
3) prevent spread
4) prevent recurrence
Non-pharm strategies (3)
reduce symptoms
- gently remove crusts with warm water or mild soap and water
- warm saline compress x 10-15min TID-QID (dec itch)
prevent spread (other areas of body and other ppl)
- no scratch
- wash b4/aft touch
- cover draining lesion w/ clean/dry bandage
- no share towel
- wash linens sep from other ppl
- discard used compress/bandages imm OR wash in hot water
- stay home from school until 24hrs antimicrobial therapy OR lesions dry
prevent recurrence
- trim fingernails
- manage pruritis appropriately
- wash cuts, scrapes, and insect bites ASAP and cover w/ bandage
nonpharm: reduce symptoms (2)
gently remove crusts with warm water or mild soap and water
warm saline compress x 10 to 15 minutes TID to QID to decrease itch
nonpharm: prevent spread (6)
- avoid scratching lesions
- wash hands before and after touching lesions
- cover draining lesions with clean dry bandage
- avoid sharing towels and wash patients linens separately
- discard used compresses and bandages immediately or wash in hot water
- stay home from school until 24 hours of antimicrobial therapy OR lesions are dry and no longer oozing
how long should a child stay home from school
24hrs of antimicrobial OR when lesions dry and not oozing
nonpharm: prevent recurrence (3)
trim fingernails
manage pruritis appropriately
wash cuts, scrapes, and insect bites ASAP and cover with bandage
do you need to use antibiotics to cure bac infection
NO, self resolving in 2-4wks with low risk of bad shit
How should you decide if IMP requires topical antibiotic or not
shared decision making
no topical antibiotic vs topical antibiotic: symptoms
NO TA
- lesions usually resolve 2-4wk and complications are rare
WITH TA
- lesions resolve about 1 to 2 days faster
no topical antibiotic vs topical antibiotic: spread
NO TA
- increased risk of spread, patient will need avoid contact with others
WITH TA
- decreased risk of spread
- patient may return to school 24 hours after start
no topical antibiotic vs topical antibiotic: side effects
NO TA
- no risk of antibiotic resistance or side effects
WITH TA
- CAUSES antibiotic resistance
- may cause local irritation or allergic contact dermatitis
Topical antimicrobial therapy for mild uncomplicated non-bullous impetigo (3)
mupirocin 2%
fusidic acid 2%
ozenoxacin 1%
mupirocin 2% (4)
- effectiveness
- dose
- type of topical (problematic?)
- expense
- as effective as oral antibiotics with fewer SEs
- TID x 5-7 days
ointment or cream available
- ointment
+ not good for oozing lesions
+ kids touch a lot and fingerprint all you shit - least expensive
Fusidic acid 2%
- effectiveness
- dose
- type of topical
- expense
- as effective as oral antibiotics with fewer side effects
TID x 5-7 days
- ointment or CREAM (use cream bc ointment probs)
- intermediate in price range to ozenoxacin 1%, mupirocin 2%
Ozenoxacin 1%
- effectiveness
- dose
- type of topical
- cost
Superior to placebo, hasnt been studies vs other antibiotics (drawback)
BID x 5-7 days
cream
most expensive
what about oral antibiotics? (2)
patients who have not seen improvement/resolution after 24-48hrs of topical therapy
patients with severe disease or immunocompromise (red flags for referral)
combination of topical and oral therapy
no evidence or logic to support
nonRx topical antibiotic creams (2)
inferior to Rx topical therapies
associated with contact dermatitis
what age group do you often see this in
preschool children
what requires referral (2)
patients with:
- bullous impetigo
- NBI with systemic fts of extensive disease
decision to start topical antimicrobial therapy falls on who
patient and caregiver values and preferences
