Impetigo contagiosa, large-bubble L01.0

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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bullous impetigo; contagious staphylogenous impetigo; Impetigo contagiosa large vesicles; impetigo staphylogenes; Large vesicles Impetigo contagiosa; mansoni pyosis; staphylodermia bullosa

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Impetigo contagiosa with large flaccid blisters.

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Virulent, coagulase-positive Staphylococcus aureus (especially phage group II, type 71).

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Mostly infection with epidermolysin-forming staphylococci (high contagiousness, endemics!). The blisters are caused by a staphylococci toxin (epidermolysin). This leads to toxin-induced acantholysis in the area of the str. granulosum, a process which can be interpreted as a localised " Staphylococcal Scalded Skin Syndrome" (see also Staphylogenic Lyell Syndrome).

Clinical features
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Large, flabby blisters on a reddened background. Hypopyon bubbles with initially clear, then whitish-grey, creamy purulent content. Destruction of the bubble cover, formation of encrusted, eroded areas with bubble remnants at the edges and Collerette-like scaling. Scarless healing. Special form: Staphylogenic pemphigoid of the newborn.

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Intraepidermal blistering. The blisters contain fibrin and neutrophil leucocytes. Furthermore, spongiosis and subepidermal inflammatory reactions are observed.

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Cover infected skin areas with gauze or with an adapted tubular bandage (to avoid the transmission of bacteria through the scratching finger). Do not use a plaster for fastening. Crusts are best softened with ointments or soft pastes (e.g. 2% Clioquinol titanium oxide paste), if necessary with disinfectant solutions such as quinolinol solution (e.g. Chinosol 1:1000) or R042 or polihexanide (Serasept®, Prontoderm®). Instead of Clioquinol ointment, a 2% quinolinol ointment (alternatively: polyvidon iodine ointment such as Betaisodona®) or a disinfecting soft zinc paste (beneficial in case of infestation of intertriginous areas) can be chosen. Local antibiotics, e.g. Infectopyoderm, Fucidine, Refobacin, have proven to be effective.

Change dressing twice a day: Put on gloves, dab the flock with pure olive oil, gently remove crusts, open pustules and blisters with a cannula, treat again with ointments. Disinfecting baths are beneficial for the healing process (e.g. with quinosol 1:1000, potassium permanganate (light pink) or polyvidon iodine solution).

Internal therapy
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Antibiotics are unavoidable in large herds. The administration is usually carried out after an antibiogram (however, if the clinical picture is clear, an oralcephalosporin can be started spontaneously. Therapy of choice are oralcephalosporins (cephaclor, cephaloxin) or penicillinase-resistant penicillins (flucloxacillin, dicloxacillin). For penicillin allergy is Clindamycin (20-30mg/kgKG).

Preparations and dosages see below impetigo.

In case of itching a sedative antihistamine is recommended, e.g. clemastine (e.g. Tavegil syrup 2-4 teaspoons/day), Dimetinden (e.g. Fenistil syrup 3-6 teaspoons) or the non-sedative Desloratadine (e.g. Aerius syrup 1/2-1 measuring spoon). The substances are available in an application form suitable for children (juices).


Please ask your physician for a reliable diagnosis. This website is only meant as a reference.


Last updated on: 29.10.2020