Impetigo is a highly contagious infection in the epidermis or outer layers of the skin, primarily caused by Staphylococci bacteria. The diagnosis is clinical, but it’s critical to consider the patient history, your findings during a physical exam, and lab tests where necessary.
There are two forms of impetigo, known as nonbullous and bullous impetigo respectively. Nonbullous impetigo is the most common form, characterized by rupturing blisters. S. aureus is the primary cause, especially in the early stages, but Streptococci bacteria tend to dominate in the later stages.
Bullous impetigo, on the other hand, is caused solely by S. aureus and is most prevalent in infants and children. The bullae, or large fluid-filled blisters, appear as bacteria release toxins. Untreated or unresponsive bullous impetigo may develop into a deep ulcerated infection known as ecthyma.
Some children or adults with pre-existing skin conditions, such as atopic dermatitis, may be more prone to infections. Both forms often appear after a small break in the skin.
Impetigo may be easily mistaken for other diseases, but a few signs and symptoms can help you identify the condition. Patients may describe a painless itchy rash with red spots progressing to fluid-filled blisters. You may also see:
The golden-yellow crust is the tell-tale sign of impetigo. It appears as the blisters rupture and leak yellow pus that dries.
Impetigo may mimic some conditions. Consider the following in your differential diagnosis:
Impetigo often clears with treatment within five days. However, early treatment is essential to prevent scarring, cellulitis, or hyper- or hypopigmentation.
Antibiotics are the primary treatment for impetigo. You can prescribe topical or oral antibiotics, though a topical form is as effective for mild or moderate impetigo with fewer side effects. Effective topical antibiotics include:
You may need to combine topical antibiotics with oral for widespread infections, systemic symptoms, or family clusters. Oral antibiotics should cover group A beta-hemolytic Streptococcus and S. aureus. Effective oral medications include:
If your patient has a penicillin allergy, consider the following:
If your community has known cases of MRSA or the rash doesn’t respond to treatment, take a swab to test for culture and sensitivity. Prescribe the oral antibiotics listed above for penicillin allergies with mupirocin cream, Polysporin triple therapy, or ozenoxacin 1% cream.
Impetigo is highly contagious and spreads through direct contact with the rash or contaminated personal items such as linens, towels, and facecloths. Encourage frequent handwashing with soap and water, and instruct patients to avoid touching their faces or sharing personal items.
Impetigo is a common and often recurring infection. MDBriefCase offers many online and accredited courses on infectious diseases and other conditions to help you stay current on new evidence and best practices. Join for free today.
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