32. IMPETIGO

Impetigo is a highly contagious superficial bacterial skin infection, commonly seen in children but it can affect people of all ages. It is characterized by honey-colored crusts, redness, and itching. Early treatment helps prevent spread and complications.

Causes

Impetigo is caused by:

  • Staphylococcus aureus (most common)
  • Streptococcus pyogenes

It spreads through close contact, sharing towels, scratching, or poor hygiene.

Types of Impetigo

  • Non-bullous impetigo: Most common form; small vesicles that rupture, leaving honey-colored crusts.
  • Bullous impetigo: Large fluid-filled blisters caused mainly by Staphylococcus aureus.
  • Ecthyma: Deeper form causing ulcers with thick crusts.

Symptoms

  • Red sores or blisters
  • Honey-colored crusts on the skin
  • Itching or irritation
  • Swollen lymph nodes (sometimes)
  • Fluid-filled blisters (bullous type)

Diagnosis

  • Clinical examination of typical skin lesions
  • Swab culture for recurrent or severe cases
  • Assessment of hygiene, recent injuries, or insect bites

Treatment

1. Topical Antibiotics

  • Mupirocin ointment – first-line treatment
  • Retapamulin

2. Oral Antibiotics

Used for widespread or severe infections.

  • Amoxicillin-clavulanate
  • Cephalexin
  • Clindamycin (if MRSA suspected)

3. General Measures

  • Wash affected areas gently with soap and water
  • Remove crusts with warm compresses
  • Keep fingernails short to prevent scratching
  • Avoid close contact until treatment starts

Complications

  • Cellulitis
  • Ecthyma (deep skin infection)
  • Post-streptococcal glomerulonephritis
  • Scar formation (rare)

Prevention

  • Maintain good personal hygiene
  • Avoid sharing towels or clothes
  • Wash hands frequently
  • Clean minor cuts and insect bites promptly
  • Keep infected person’s belongings separate

Patient Counseling

  • Apply topical antibiotics exactly as prescribed
  • Do not scratch the lesions
  • Wash bedding and clothing in hot water
  • Keep sores covered to prevent spread
  • Return if symptoms worsen or new sores appear

Detailed Notes:

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