IMPETIGO

A very superficial bacterial infection of the epidermis (upper/outer layer of skin)

Cause

  • Streptococcus or staphylococcus infection, or both

Clinical features

  • Common in children
  • Lesions usually on face, head, and hands as bullae, or small brown crusts on an erythematous base
  • In some cases, large flaccid bullae containing pus and serum are formed commonly in the axilla and groin

Differential diagnosis

  • Pemphigus

Investigations

  • Pus swab for Gram stain
  • Culture and sensitivity (exudate from unroofed lesion)

MANAGEMENT

Cleaning

  • Clean affected area with chlorhexidine solution 0.05%

Antiseptic: if infection mild and localised (<5 lesions)

  • Apply gentian violet aqueous paint 0.5% every 12 hours for 3 days
  • OR apply silver sulphadiazine 1% cream 12 hourly for 5 days

Antiseptic: if infection mild and localised (<5 lesions)

  • Apply gentian violet aqueous paint 0.5% every 12 hours for 3 days
  • OR apply silver sulphadiazine 1% cream 12 hourly for 5 days
  • Keep skin clean by frequent washing and drying
  • Use soap and water to soften, and gently remove any superficial crusts

Systemic antibacterial: if signs of regional or systemic spread, e.g., pyrexia, >5 lesions

  • Cloxacillin 250–500 mg every 6 hours before food for 7 days
    Child: 12.5–25 mg/kg per dose
  • Or in penicillin allergy, erythromycin 250-500 mg every 6 hours for 7 days
    Child: 7.5 mg/kg per dose
Note
  • Impetigo is contagious until the lesions have dried up

Prevention

  • Proper hygiene with use of antiseptic soap