Impetigo
Summary/Definition
Impetigo, or superficial pyoderma, is a highly contagious skin infection caused by a bacterial infection that occurs primarily in children during the hot and humid summer months. The disease produces blister-like pustular rashes on the skin and can be classified as contact (non-bullous) and vesicular (bullous) impetigo. Contact impetigo accounts for 70% of cases. It is most commonly associated with staphylococcal and streptococcal infections. Impetigo is a contagious, predominantly superficial skin disease and is at high risk during the hot, humid summer months or when sanitation and hygiene are compromised.
Symptoms
Contact impetigo is the most common form. When infected, the disease begins quickly with the appearance of red spots (erythema) measuring 2 to 4 mm. Vesicles filled with serum then appear on the reddened skin. After the vesicles rupture, moist superficial ulcers form that are covered with copper-colored crusts. These crusts fall off over time, and the central part of the skin underneath begins to gradually regenerate. The crusts can come off easily, such as when touching hands or wiping with a towel, which can help spread the infection to other areas of the skin. Impetigo most commonly affects the skin of the hands, feet, and face. In severe cases, lymph nodes near the affected areas may become enlarged or body temperature may rise. The affected skin usually heals on its own within two weeks. It should be noted that impetigo caused by purulent streptococci can cause acute glomerulonephritis (AGN) in 5% of cases.
Bullous impetigo occurs primarily in children and neonates during the summer months. In neonates, lesions may spread over the entire body, and, because of the high degree of contagiousness, there is a risk of transmission to other children in the neonatal unit. In the early stages of the disease, single vesicles (1-2 units) appear on the skin of the face, body, arms and legs, which then enlarge to form large watery blisters. The blisters burst easily and do not form crusts. The edges of the vesicles are clear and there is little erythema around the affected areas. Vesicles usually do not form on the scalp. In the early stages of the disease, there are no systemic symptoms, but later signs such as general lethargy, diarrhea, fever, and hypothermia may occur. If impetigo is accompanied by sepsis, pneumonia, or meningitis, it can lead to serious complications, including death.
Diagnostics
Contact impetigo is relatively easy to diagnose on the basis of clinical features without laboratory testing. However, if necessary, the diagnosis can be confirmed by Gram staining of the exudate or by bacterial culture of the discharge. In bullous impetigo, Gram-positive bacteria can be detected by collecting fluid from vesicles and performing culture. An elevated white blood cell count is seen in approximately 50% of patients. If impetigo recurs frequently, the possibility of nasal or genital staphylococcus should be considered.
Treatment and course of the disease
In the absence of systemic symptoms and for minor skin lesions, it is recommended to begin treatment as follows: first clean the affected area with water and soap, then disinfect with a solution of povidone or hydrogen peroxide, then apply an antibiotic ointment. Specifically, remove and clean the area under the crust with an antibiotic and apply Bactroban ointment. If the disease affects a large area of skin, it is recommended to inject dicloxacillin and erythromycin for one week. If the condition is caused by erythromycin-resistant Staphylococcus aureus or if impetigo is associated with complications, antibiotics such as Augmentin or Cephalexin, which contain amoxicillin and clavulanic acid, may be indicated for 10 days. Other medications include azithromycin and clarithromycin.
