Impetigo

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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)

ManagementTreatment

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