Impetigo
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A very superficial and highly contagious bacterial infection of the epidermis (upper/outer layer of skin).
Causes
- Streptococcus species (usually pyogenes)
- Staphylococcus aureus
Signs and symptoms
- Blisters and sores on the skin and scalp.
- Superficial pustules or blisters which become oozing with yellow crusts as it spread
Differential diagnosis
- Pemphigus
- Herpes simplex
Investigations
- Skin swab for gram stain, culture and sensitivity (exudate from unroofed lesion)
Treatment objectives
- Treat infection
- Treat underlying pruritic dermatoses
- Prevent complications
Non-pharmacological and pharmacological treatment
Lesions are mild and localized
Clean lesion with:
Chlorhexidine/cetrimide diluted 1 in 20ml
OR
Betadine solution or saline
OR
Wash with betadine shampoo
Hydrogen peroxide 2%
For wet lesions
Gentian violet 0.5% - apply every 12 hours for 3 days
- Keep skin clean by frequent washing and drying
- Use soap and water to soften, and gently remove
For single or few lesions
1st line treatment
Bacitracin cream 500IU apply three times a day for 10 days
2nd line treatment
Fusidic acid 5% ointment
Apply three times a day for 10 days
Neomycin topical
Apply three times daily for 10 days
For lesions, widespread, complicated or associated with systemic features (fever, malaise, diarrhoea)
1st line treatment
Amoxicillin-clavulanate oral
400mg/57mg 12hrly
2nd line treatment
- If there is no improvement with the first line
- Patient is allergic to penicillins
Azithromycin oral
Child:
10mg /kg once daily for 3 days
Adult:
500mg once daily for 3 days
OR
Erythromycin oral
Child: 30-50mg/kg/day 2-3 divided doses for 7 days
Adult: 3g/kg in 3 divided doses for 7 days
Note: Impetigo is contagious until the lesions have dried up
Prevention
- Proper hygiene with use of antiseptic soap
Referral
- Refer conditions not responding to the above treatment to a specialist.