Impetigo - A Brief Discussion.

Introduction: This is the most superficial of the bacterial skin infections. It is one of the most common skin infections in children. but can also occur in adults.

Etiology: It is caused by Streptococcus pyogenes or Staph. aureus infecting the epidermal layer of the skin.

Clinical features: Because it is so superficial, there is weeping, crusting, and oozing of the skin.
Symptoms start with red or pimple-like sores surrounded by red skin. These sores can be anywhere, but usually occur on the face, arms and legs. The sores fill with pus, then break open after a few days and form a thick crust. They are often itchy, but scratching them can spread the sores.

Impetigo is contagious and can be spread to others through close contact or by sharing towels, sheets, clothing, toys, or other items.

Diagnosis: A specific microbiologic diagnosis is rarely made or necessary. It is mostly diagnosed by the clinical appearance of  “weeping, oozing, honey-colored lesions.”


Treatment
·· Topical mupirocin or retapamulin (mupirocin has greater activity against MRSA, bacitracin has less efficacy as a single agent)
·· Severe disease: Oral dicloxacillin or cephalexin
·· Community-acquired MRSA (CA-MRSA): TMP/SMZ; clindamycin is sometimes useful; linezolid is definitely effective.

In case of Penicillin allergy:
-- Rash: Cephalosporins are safe.
-- Anaphylaxis: Clindamycin, doxycycline, linezolid
-- Severe infection with anaphylaxis: Vancomycin, telavancin, linezolid, daptomycin