Superficial Bacterial skin infections (topical abx for Non bullous impetigo and folliculitis)

Question 1

What is the most common causative agent of impetigo and folliculitis?

Answer 1

staph aureus

Question 2

What is impetigo?
- how contagious is it?

Answer 2

is a common and highly contagious skin infection that mainly affects infants and young children. It usually appears as reddish sores on the face, especially around the nose and mouth and on the hands and feet. Over about a week, the sores burst and develop honey-colored crusts.
- very contagious, mainly affects young children.

Question 3

what is folliculitis?

Answer 3

Superficial bacterial infection involving part of the hair follicle(s).

Question 4

whats the difference betwen folliculitis, furuncles and carbuncles?

-are furuncles and carbuncles appropriate for self care?

Answer 4

Furuncles or boils usually begin as folliculitis, but develop into a deep folliculitis penetrating into the dermis and involving the entire hair follicle. This may progress to carbuncles, an aggregate of furuncles which penetrates to deeper layers of skin and subcutaneous fat. Furuncles and carbuncles may require systemic antibiotic treatment and require referral.

• no. require referal.

Question 5

Describe the signs/sx of NON-BULLOUS impetigo vs folliculitis.

Answer 5

Non bullous impetigo:
- age affects mainly 2-5 yrs.
- begins as papules that develop into blisters surrounded by redness. when blsiters break a wk later, secrete a yellowish exudate that dries to form a honey colored crust.
- systemic sx RARE.
**NOTE: BULLOUS impetigo DOES NOT form a HONEY colored cust .

Folliculitis:
- appear as small, red papules at the base of hair follicles.
- area often tender and sore to touch
- Mild infections are self-limiting and clear within a few days with basic non-pharmacologic measures

Question 6

what are 3-4 red flags for non bullous impetigo and folliculitis?

Answer 6

• immunocompromised (HIV, cancer, long term systemic steroids (>20 mg prednisone for longer than 14 days).
• systemic sx
• frequent recurrences (within a few months)
• BULLAE OR FLUID FILLED BLSITERS that DONT SECRETE HONEY COLORED FLUID -> indicates bullous impetigo.
• suspect MRSA (recent hospitalization, previous infection with MRSA, injection drug use/shaving or sharing equipment that’s not sterilized, tattooos).
• Unable to confirm patient’s self diagnosis and/or self-care is not appropriate. Refer to the patient’s primary care provider for further investigation and/or supervised therapy.

Question 7

What is 3-4 non pharm tips for folliculits?

• for specifically impetigo?

Answer 7

Folliculitis and impetigo:
- warm water compress - 10-15 mins 3-4 times daily.
- keep fingernails short and avoid scratching or picking at lesions.
- wash hands before and after touching area

impetigo:
- Keep infected person’s clothing and towels separate from other members of the family; launder frequently.

Question 8

What are the Prescription options for both impetigo and folliculits. what is their dosage regimen?

Answer 8

Mupirocin 2% Cream or Ointment:
Apply to infected area THREE times a day UNTIL RESOLVED (up to 10 days).

Fusidic Acid 2% Cream or Sodium Fusidate 2% Ointment:
Apply to infected area THREE to FOUR times a day UNTIL RESOLVED (for 7 to 14 days typically).

Question 9

What are some key monitoring points for both impetigo and folliculitis? for both efficacy and safety?

eficacy: how long does it take for leasions to clear?
safety: when should they see a doctor (3 things)?

Answer 9

• efficacy: Lesions should clear in about a wk.
• safety: if any development of systemic sx (fever), progression to boils/worsening, no improvement or worsening in 48 hours.

Question 10

When should you follow up?

Answer 10

48 hours*****