Impetigo_Flashcards
What is impetigo and its common causes?
Impetigo is a superficial bacterial skin infection typically caused by Staphylococcus aureus or Streptococcus pyogenes. It often occurs as a primary infection or as a complication of conditions like eczema, scabies, or insect bites.
Where on the body does impetigo usually develop and how does it spread?
Impetigo commonly develops on the face, flexures, and limbs not covered by clothing. It spreads through direct contact with discharges from infected scabs or indirectly via objects like toys and clothing.
What are the typical features of impetigo?
‘Golden’, crusted skin lesions are typical of impetigo, often found around the mouth. The condition is highly contagious.
How is limited, localized impetigo managed?
For limited, localized impetigo, hydrogen peroxide 1% cream is recommended. Topical antibiotics such as fusidic acid or mupirocin may be used, with mupirocin particularly for MRSA or suspected fusidic acid resistance.
What is the treatment for extensive impetigo?
Extensive impetigo is treated with oral flucloxacillin, or oral erythromycin if penicillin-allergic.
When should children with impetigo be excluded from school?
Children with impetigo should be excluded from school until lesions are crusted and healed, or 48 hours after commencing antibiotic treatment.
An 8-year-old boy is brought to see his GP as he has developed a rash on his face over the last 3 days. On inspection, the rash has a yellow, crusty appearance and is located in one discrete patch just below his mouth. What is the most appropriate treatment option?
Aciclovir
Hygiene measures
Flucloxacillin
Hydrogen peroxide 1%
Topical fusidic acid
Hydrogen peroxide 1%
This patient has developed impetigo — a common skin infection caused by Staphylococcus aureus or Streptococcus pneumoniae. It is often described as having a golden-yellow, crusted appearance. Hygiene measures should be recommended (e.g. hand washing after touching the lesions) to all patients. The 1st line treatment for localised disease is topical fusidic acid. More extensive disease will be treated using oral flucloxacillin. Clarithromycin is an alternative that can be used in penicillin-allergic patients. School exclusion should be advised until the lesions have crusted over. Impetigo usually heals without causing any skin scarring. Aciclovir is an antiviral agent that is mainly used to treat herpes simplex virus infections.
SUMMARISE
Impetigo
Impetigo is a superficial bacterial skin infection usually caused by either Staphylcoccus aureus or Streptococcus pyogenes. It can be a primary infection or a complication of an existing skin condition such as eczema (in this case), scabies or insect bites. Impetigo is common in children, particularly during warm weather.
The infection can develop anywhere on the body but lesions tend to occur on the face, flexures and limbs not covered by clothing.
Spread is by 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. The incubation period is between 4 to 10 days.
Features
‘golden’, crusted skin lesions typically found around the mouth
very contagious
Management
Limited, localised disease
NICE Clinical Knowledge Summaries now recommend hydrogen peroxide 1% cream for ‘people who are not systemically unwell or at a high risk of complications’
the change was announced in 2020 by NICE and Public Health England and seems aimed at cutting antibiotic resistance
the evidence base shows it is just as effective at treating non-bullous impetigo as a topical antibiotic
topical antibiotic creams:
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
Extensive disease
oral flucloxacillin
oral erythromycin if penicillin-allergic
School exclusion
children should be excluded from school until the lesions are crusted and healed or 48 hours after commencing antibiotic treatment
