Impetigo

For the band, see Impetigo (band).
Impetigo

A severe case of facial impetigo
Classification and external resources
Pronunciation /ɪmpᵻˈtaɪɡoʊ/
Specialty Dermatology, infectious disease
ICD-10 L01
ICD-9-CM 684
DiseasesDB 6753
MedlinePlus 000860
eMedicine derm/195 emerg/283 med/1163 ped/1172
Patient UK Impetigo
MeSH D007169

Impetigo is a contagious bacterial skin infection most common among preschool children.[1] People who play close contact sports, such as wrestling are also susceptible, regardless of age. Antibiotic creams or pills are often used as a remedy.

Globally impetigo affected about 140 million people (2% of the population) in 2010.[2] Impetigo is not as common in adults. The name derives from the Latin impetere ("assail"). It is also known as school sores.[3]

Classification

Impetigo on the neck

Contagious impetigo

This most common form of impetigo, also called nonbullous impetigo, most often begins as a red sore near the nose or mouth which soon breaks, leaking pus or fluid, and forms a honey-colored scab,[4] followed by a red mark which heals without leaving a scar. Sores are not painful, but they may be itchy. Lymph nodes in the affected area may be swollen, but fever is rare. Touching or scratching the sores may easily spread the infection to other parts of the body.[5] Ulcerations with erythema and scarring also may result from scratching or abrading of the skin.

Bullous impetigo

Bullous impetigo

Bullous impetigo, mainly seen in children younger than 2 years, involves painless, fluid-filled blisters, mostly on the arms, legs, and trunk, surrounded by red and itchy (but not sore) skin. The blisters may be large or small. After they break, they form yellow scabs.[5]

Ecthyma

In this form of impetigo, painful fluid- or pus-filled sores with redness of skin, usually on the arms and legs, become ulcers that penetrate deeper into the dermis. After they break open, they form hard, thick, gray-yellow scabs, which sometimes leave scars. Ecthyma may be accompanied by swollen lymph nodes in the affected area.[5]

Causes

It is primarily caused by Staphylococcus aureus, and sometimes by Streptococcus pyogenes.[6] Both bullous and nonbullous are primarily caused by S. aureus, with Streptococcus also commonly being involved in the nonbullous form.[7]

Predisposing factors

Predisposing factors include poor hygiene, malnutrition, and anemia.[8] Impetigo occurs more frequently among people who live in warm climates.[8]

Transmission

The infection is spread by direct contact with lesions or with nasal carriers. The incubation period is 1–3 days after exposure to Streptococcus and 4–10 days for Staphylococcus.[9] Dried streptococci in the air are not infectious to intact skin. Scratching may spread the lesions.

Diagnosis

Impetigo is usually diagnosed based on its appearance. It generally appears as honey-colored scabs formed from dried serum, and is often found on the arms, legs, or face.[6]

Treatment

For generations, the disease was treated with an application of the antiseptic gentian violet.[10] Today, topical or oral antibiotics are usually prescribed. Mild cases may be treated with bactericidal ointment, such as mupirocin.

More severe cases require oral antibiotics, such as dicloxacillin, flucloxacillin, or erythromycin. Alternatively, amoxicillin combined with clavulanate potassium, cephalosporins (first-generation) and many others may also be used as an antibiotic treatment. Alternatives for people who are seriously allergic to penicillin or infections with MRSA include doxycycline, clindamycin, and SMX-TMP. When streptococci alone are the cause, penicillin is the drug of choice.

Epidemiology

Globally, impetigo affected about 140 million people (2% of the population) in 2010.[2]

References

  1. ↑ "Impetigo - NHS Choices". www.nhs.uk. Retrieved 11 December 2014.
  2. 1 2 Vos, T (Dec 15, 2012). "Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010.". Lancet 380 (9859): 2163–96. doi:10.1016/S0140-6736(12)61729-2. PMID 23245607.
  3. ↑ Impetigo — school sores — Better Health Channel
  4. ↑ Cole C, Gazewood J (2007). "Diagnosis and treatment of impetigo". Am Fam Physician 75 (6): 859–64. ISSN 0002-838X. PMID 17390597.
  5. 1 2 3 Mayo Clinic staff (5 October 2010). "Impetigo". Mayo Clinic Health Information. Mayo Clinic. Retrieved 25 August 2012.
  6. 1 2 Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; & Mitchell, Richard N. (2007). Robbins Basic Pathology (8th ed.). Saunders Elsevier. pp. 843 ISBN 978-1-4160-2973-1
  7. ↑ Stulberg DL, Penrod MA, Blatny RA (2002). "Common bacterial skin infections.". American Family Physician 66 (1): 119–24. PMID 12126026.
  8. 1 2 Tamparo, Carol; Lewis, Marcia (2011). Diseases of the Human Body. Philadelphia, PA: F.A. Davis Company. p. 194. ISBN 9780803625051.
  9. ↑ "ISDH: Impetigo". state.in.us. Retrieved 11 December 2014.
  10. ↑ MacDonald RS (October 2004). "Treatment of impetigo: Paint it blue". BMJ 329 (7472): 979. doi:10.1136/bmj.329.7472.979. PMC 524121. PMID 15499130.

External links

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