Please enable JavaScript.
Coggle requires JavaScript to display documents.
Impetigo - Coggle Diagram
Impetigo
Management
-
-
Referral to a consultant in Communicable Disease Control is required if there is significant local outbreak eg in nursing home or school.
-
Consider referral/seek advise for: bullous impetigo (particularly in babies < 1 year), impetigo that recurs frequently, are systemically unwell or at high risk of complications. Also consider if diagnosis is uncertain.
?Public Health Scotland - Stay away from school/other childcare facilities or work until lesions are healed, dry and crusted over or 48 hours after initiation of antibiotics. Food handlers are required by law to inform employer immediately.
Refer to secondary care if concerned about complications such as sepsis, glomerulonephritis, or deeper soft tissue infection are suspected, the person is immunocompromised and infection is widespread
-
-
-
-
Differential diagnosis
-
-
-
-
-
-
-
-
Other skin disorders such as pemphigus vulgaris, bullous pemphigoid, lupus erythematosus, erythema multiforme and Sweets Syndrome.
Follow up
-
-
Reassess and consider alternative diagnosis, underlying case and previous antibiotic use
If topical antibiotic used consider short course of oral antibiotics/sending a skin swab for microbiological testing
If symptoms rapidly or significantly worsen or have not improved with completing a course of treatment
-
-
Recurrent - send skin swab for microbiological testing and consider taking a nasal swab and starting treatment for decolonisation.
Diagnosis
History
-
-
-
-
-
Clinical features including onset, evolution, duration and location of lesions
-
Investigation
-
Swabs for culture and sensitivity should be considered in cases which are persistent despite treatment, recurrent or widespread.
Clinical features
Non-bullous impetigo
Lesions can develop anywhere on the body but are most common on exposed skin on the face (in particular the peri-oral and peri-nasal areas), limbs and flexures (such as the axillae). Satellite lesions may develop following autoinoculation.
-
Lesions begin as thin walled vesicles or pustules (seldom seen on clinical examination as they rupture quickly) which release exudate forming a characteristic golden/brown crust. Once crusts have dried they separate leaving mild erythema which then fades — healing occurs spontaneously without scarring within 2-3 weeks.
-
Bullous impetigo
Lesions can occur anywhere on the body but are most common on the flexures, face, trunk and limbs.
Systemic features may occur if large areas of skin are affected and include fever, lymphadenopathy, diarrhoea and weakness.
Lesions appear as flaccid fluid filled vesicles and blisters (often with a diameter of 1-2cm) which can persist for 2-3 days. Blisters rupture leaving a thin flat yellow/brown crust. Healing usually occurs within 2-3 weeks without scarring.
Definition: Impetigo is a common superficial bacterial infection of the skin. The two main clinical forms are: Non-bullous impetigo and Bullous impetigo — bullae are fluid filled lesions which are usually more than 5mm in diameter. Impetigo can develop as a primary infection in otherwise healthy skin or as a secondary complication of pre-existing skin conditions such as eczema, scabies, or chickenpox.