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Pharm 130 > Impetigo > Flashcards

Impetigo Flashcards

1
Q

describe pustule

A

opaque coulour inside

-ex. pustules

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2
Q

describe vesicles

A

cold sore

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3
Q

define bullae

A

raised lesion with defined edge

surrounding skin may be red, dpnds on cause

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4
Q

what is the more common form of impetigo

A

non-bollous impetigo

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5
Q

Non-bullous impetigo

  • presentation
  • progression of dermatological condition/ time frame
  • where found on body
  • symptoms
A

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

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6
Q

bullous Impetigo

  • how common rel NBI
  • presentation
  • progression
  • where
  • symptoms
A

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

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7
Q

Impetigo resolution

A

usually resolve on its own ( 2-4 wks) without scarring

hypo/hyper- pigmentation possible

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8
Q

impetigo complications

A

RARE

-ex. cellulitis

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9
Q

Pathophysiology of Impetigo

A

break in the skin allows skin colonizing bacteria to penetrate

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10
Q

what skin colonizing bacteria can cause impetigo

- where found

A

group A streptococcus
staphylococcus aureus

found in warm moist places

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11
Q

what bacteria causes skin bullous form impetigo

A

toxin producing strains of S.aureus

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12
Q

Risk factors for skin colonizing bacteria (4)

A

crowding
poor hygiene
season (summer and fall)
infants (bullous) and preschool children (NBI)

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13
Q

risk factors due to broken skin (3)

A

burns
scrapes and cuts
anything that causes scratching

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14
Q

(7) Red flags for referral of impetigo

A
  • fever
  • malaise
  • significant pain
  • immunocompromise
  • extensive skin involvement (2-3 patches) (widespread erythema suggestive of cellulitis)
  • recurrent episodes
  • suspected bullous impetigo
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15
Q

what qualifies as extensive skin involvement (2)

A

more than 2 or 3 small patches

widespread erythema suggestive of cellulitis

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16
Q

what does episodes of impetigo warrant (other than referral, done by doctor)

A

may require additional diagnostics +/- S.aureus decolonization

17
Q

GoT for mild uncomplicated non-bullous impetigo (4)

A

1) cure infection
2) reduce symptoms
3) prevent spread
4) prevent recurrence

18
Q

Non-pharm strategies (3)

A

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
19
Q

nonpharm: reduce symptoms (2)

A

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

20
Q

nonpharm: prevent spread (6)

A
  • 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
21
Q

how long should a child stay home from school

A

24hrs of antimicrobial OR when lesions dry and not oozing

22
Q

nonpharm: prevent recurrence (3)

A

trim fingernails

manage pruritis appropriately

wash cuts, scrapes, and insect bites ASAP and cover with bandage

23
Q

do you need to use antibiotics to cure bac infection

A

NO, self resolving in 2-4wks with low risk of bad shit

24
Q

How should you decide if IMP requires topical antibiotic or not

A

shared decision making

25
Q

no topical antibiotic vs topical antibiotic: symptoms

A

NO TA
- lesions usually resolve 2-4wk and complications are rare

WITH TA
- lesions resolve about 1 to 2 days faster

26
Q

no topical antibiotic vs topical antibiotic: spread

A

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
27
Q

no topical antibiotic vs topical antibiotic: side effects

A

NO TA
- no risk of antibiotic resistance or side effects

WITH TA

  • CAUSES antibiotic resistance
  • may cause local irritation or allergic contact dermatitis
28
Q

Topical antimicrobial therapy for mild uncomplicated non-bullous impetigo (3)

A

mupirocin 2%

fusidic acid 2%

ozenoxacin 1%

29
Q

mupirocin 2% (4)

  • effectiveness
  • dose
  • type of topical (problematic?)
  • expense
A
  • 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
30
Q

Fusidic acid 2%

  • effectiveness
  • dose
  • type of topical
  • expense
A
  • 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%
31
Q

Ozenoxacin 1%

  • effectiveness
  • dose
  • type of topical
  • cost
A

Superior to placebo, hasnt been studies vs other antibiotics (drawback)

BID x 5-7 days

cream

most expensive

32
Q

what about oral antibiotics? (2)

A

patients who have not seen improvement/resolution after 24-48hrs of topical therapy

patients with severe disease or immunocompromise (red flags for referral)

33
Q

combination of topical and oral therapy

A

no evidence or logic to support

34
Q

nonRx topical antibiotic creams (2)

A

inferior to Rx topical therapies

associated with contact dermatitis

35
Q

what age group do you often see this in

A

preschool children

36
Q

what requires referral (2)

A

patients with:

  • bullous impetigo
  • NBI with systemic fts of extensive disease
37
Q

decision to start topical antimicrobial therapy falls on who

A

patient and caregiver values and preferences

Pharm 130 (13 decks)

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