Impetigo

Question 1

What is it

Answer 1

infection of the skin caused by Staphylococcal and Streptococcal bacteria

Question 2

How does it present

Answer 2

It classically presents as a pruritic rash with discrete patches that have a golden crusting
Patients may also be febrile
It commonly occurs in infants and school-age children

Question 3

Where does it occur

Answer 3

face, flexures and limbs not covered by clothing.

Question 4

How is it spread

Answer 4

direct contact with discharges from the scabs of an infected person. The bacteria invade the skin through minor abrasions and then spread to other sites by scratching. Infection is spread mainly by the hands, but indirect spread via toys, clothing, equipment and the environment may occur.

Question 5

How to manage

Answer 5

hydrogen peroxide 1% cream for ‘people who are not systemically unwell or at a high risk of complications’

Question 6

What else can be used for management

Answer 6

topical fusidic acid
topical mupirocin should be used if fusidic acid resistance is suspected
MRSA is not susceptible to either fusidic acid or retapamulin. Topical mupirocin should, therefore, be used in this situation

Question 7

What to do in extensive disease

Answer 7

oral flucloxacillin
oral erythromycin if penicillin-allergic

Question 8

Can kids go school

Answer 8

School exclusion
children should be excluded from school until the lesions are crusted and healed or 48 hours after commencing antibiotic treatment