Impetigo (overview) L01.1

Author: Prof. Dr. med. Peter Altmeyer

All authors of this article

Last updated on: 29.10.2020

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Definition
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Not stringently used term for a superficial, purulent, contagious, non follicularly bound, bacterial skin infection caused predominantly by coagulase-positive staphylococci (mostly phage group II, phage type 71) in < 10% by haemolytic group A streptococci (Streptococcus pyogenes). Mixed infections with both pathogens are rarer. The infection preferentially affects children.

Classification
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A distinction is made:

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Etiopathogenesis
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Smear infection through direct physical contact, less frequently via contaminated objects. Nasal and perineal infections with Staphylococcus aureus should also be considered as a source of infection.

Manifestation
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Ubiquitous pyoderma, which occurs mainly in children between 2 and 5 years of age. Most common bacterial disease in children. It is not uncommon for the infection to be preceded by a rhinitis (pre-damage to the skin through nasal secretions).

Histology
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Subcorneal bladder or pustule with single or mass neutrophil leukocytes.

Diagnosis
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Swab from blisters or pustules and bacterial culture on blood agar. Gram staining (Gram-positive cocci).

Therapy
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In case of itching, a sedative antihistamine is recommended, e.g. Clemastine (Tavegil Syrup 2-4 teaspoons/day), Dimetinden (e.g. Fenistil Syrup 3-6 teaspoons) or the non-sedative Desloratadin (e.g. Aerius Syrup 1/2-1 measuring spoon).

External therapy
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In the case of small foci, local treatment with Fucidine or Refobacin ointment is indicated. Additional disinfecting compresses, e.g. with quinosol (e.g. R042 ).

Internal therapy
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Antibiosis after antibiogram with beta-lactamase-resistant antibiotics, e.g. cephalosporins

Prophylaxis
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In case of recurrent infections, rehabilitation of chronic germ carriers (nose, perianal)!

Tables
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Antibiotic therapy for contagious impetigo

Pathogen

antibiotic

Example preparation

Daily dosages

Unit

Age in years

¼

½

1

3

7 ½

12

Average body weight (kg)

5,5

7,5

10

14

24

38

penicillin-sensitive Streptococci (MHK < 0.1 μg/ml)

Penicillin V

Isocillin

0,3

0,36

0,45

0,6

0,9

1,2

million IU

For penicillin intolerance: Erythromycinethylsuccinate

Sanasepton forte

250

300

375

500

750

1000

mg

Staphylococci

Dicloxacillin

InfectoStaph

330

400

500

670

1000

1330

mg

Flucloxacillin

Staphylex

170

200

250

330

500

670

mg

Note(s)
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The term "impetigo" is not used uniformly in international literature. Older works also refer to pustular, non-bacterial skin diseases such as " Impetigo herpetiformis" or " Impetigo scabida". The term impetigo is often used synonymously with pyoderma or bacterial folliculitis (see below: ostiofolliculitis). Secondary, bacterial, purulent superimposed skin diseases are called impetiginized (see below impetiginization).

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Incoming links (7)

Acantholysis; Eosinophilic pustular folliculitis; Epidermolysis bullosa junctionalis, generalized severe (historical: Herlitz type); Herpespsis of the newborns; Impetigo, non bullous; Pityriasis amiantacea; Quinolinol sulphate monohydrate solution 0,1 % (nrf 11.127.);

Outgoing links (11)

Cephalosporins; Clemastine; Desloratadine; Dimetinden; Folliculitis superficial; Impetiginization; Impetigo contagiosa, large-bubble; Impetigo herpetiformis; Impetigo, non bullous; Pityriasis amiantacea; ... Show all

Disclaimer

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

Authors

Last updated on: 29.10.2020

Author: Prof. Dr. med. Peter Altmeyer Prof. Dr. med. Peter Altmeyer

Images (2)

Impetigo contagiosa: Massive pyoderma of the facial skin.
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