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Impetigo: - Coggle Diagram
Impetigo:
Differentials
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Bacterial skin infections such as cellulitis, ecthyma, erysipelas, staphylococcal scaled skin syndrome, and necrotizing fasciitis.
Fungal skin infections such as candidiasis, tinea corporis or tinea capitis.
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Other skin disorders such as pemphigus vulgaris, bullous pemphigoid, lupus erythematosus, erythema multiforme and Sweets Syndrome.
Management
Advice to stay away from school/work until the lesions are dry and scabbed over or, if the lesions are still crusted or weeping, for 48 hours after antibiotic treatment has started.
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Advice to reduce transmission- good hygiene with soap and water, own towel, no scratching
non-bullous infection with topical hydrogen peroxide 1% apply tds for five days, or a topical antibiotic -Fusidic acid 2% (apply three times a day for 5 days), or
Mupirocin 2% (apply three times a day for 5 days)
More extensive, severe or bullous infection may require oral antibiotics (flucloxacillin or clarithromycin if allergic to penicillin) for five days (or seven days depending on clinical judgment).
Worsening advice if no improvement, treatment failure, symptoms worsen or recurs
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widespread non bullous- topical or oral antibiotic who are not systemically unwell or at high risk of complications. Do not treat with both.
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Symptoms
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Non-bullous impetigo presents with thin walled vesicles or pustules (seldom seen on clinical examination as they rupture quickly) which release exudate forming a golden/brown crust. Usually asymptomatic, but may be mild itch, Mouth and nose commonly affected.
Bullous impetigo -common in infants, older children and adults. Flaccid fluid filled vesicles and blisters (often with a diameter of 1-2cm) which can persist for 2-3 days. These blisters rupture leaving a thin flat yellow/brown crust.
occur on the flexures, face, trunk and limbs and can be particularly widespread in infants.
Systemic features (such as fever and lymphadenopathy) may occur if large areas of skin are affected.
Diagnosis
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swab only if recurring, persistent or widespread
Referral
Refer to secondary care
Complications of impetigo (such as sepsis, glomerulonephritis, or deeper soft tissue infection) are suspected.
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Consider referral or seek specialist advice for people with impetigo if bullous impetigo, particularly in babies (aged 1 year and under).:
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Also consider referral if the diagnosis is uncertain — consider other conditions which may present with similar clinical features.
Referral to a consultant in Communicable Disease Control is required if significant local outbreak in school, or nursing home etc