Last Updated on by frcemuser

Impetigo is a common contagious pyogenic infection of the super􀃗cial layers of the skin. The most commonly implicated organism is Staphylococcus aureus followed by Streptococcus pyogenes. Impetigo predominantly affects children.

The most common form is non-bullous. Lesions begin as vesicles or pustules, and rapidly burst evolving into gold crusted plaques, typically 2 cm in diameter. The area around the mouth and nose is most commonly affected, although other areas of the face and the extremities may also be involved. Satellite lesions may occur due to autoinoculation. The lesions are usually asymptomatic but there may be some itching.

Bullous impetigo is rare and most commonly affects neonates. Bullous impetigo presents with painful flaccid, fluid-filled vesicles and blisters that are usually at least 1 – 2 cm in diameter. These easily burst leaving raw skin, and eventually form thin, flat, brown-to-golden crusts. These lesions tend to affect the axillae, neck folds and nappy area rather than the face.

Diagnosis is usually clinical but skin swabs should be taken if infection is very extensive or severe, recurrent or refractory to treatment.

Impetigo usually heals completely without scarring or complications. Patients should be advised about hygiene measures to aid healing and stop spread of infection; washing hands after applying treatment to lesions, avoiding scratching, avoiding sharing towels/bedding etc.

Localised infection can be treated with topical fusidic acid (3 – 4 times daily for 7 days). For more extensive or severe infection, oral flucloxacillin (four times daily for 7 days) is recommended first line. Bullous infection usually requires treatment with oral antibiotics.

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