11.21 Impetigo

agk’s Library of Common Simple Emergencies

Presentation

Parents will usually bring their children in because they are developing unsightly skin lesions, which may be pruritic and are found most often on the face or other exposed areas. Streptococcal lesions consist of irregular or somewhat circular, red, oozing erosions, often covered with a yellow- brown crust. These may be surrounded by smaller erythematous macular or vesiculopustular areas. Staphylococcal lesions present as bullae which are quickly replaced by a thin shiny crust over an erythematous base.

What to do:

• Prescribe mupiricin 2% ointment (Bactroban) to the rash tid for 3-5 days. Have parents soften and cleanse crusts with warm soapy compresses before applying the antibiotic ointment.
• For severe or resistant cases, add a 10 day course of erythromycin or penicillin VK (250mg qid), or one intramuscular injection of benzathine penicillin (600,000 units im for children 6 years and younger, 1.2 million units im for children over 7 years.) For suspected staphylococcal infections use dicloxacillin (250mg qid) in place of penicillin (or prescribe erythromycin or cefadroxil).

What not to do:

• Do not routinely culture these lesions. This is only indicated for unusual lesions or lesions that fail to respond to routine therapy.

Discussion

Impetigo is usually self-limiting and it is believed that antibiotic treatment does not alter the subsequent incidence of secondary glomerulonephritis. Impetigo is very contagious among infants and young children and may be associated with poor hygiene or predisposing skin eruptions such as chicken pox, scabies, and atopic and contact dermatitis.

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