Impetigo (overview) L01.1

Author: Prof. Dr. med. Peter Altmeyer

Last updated on: 29.10.2020

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:

Non bullous impetigo (Remark: This term is synonymous with contagious small bullous impetigo).
Bullous impetigo

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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
Pathogen	antibiotic	Example preparation	Age in years						Unit
			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
penicillin-sensitive Streptococci (MHK < 0.1 μg/ml)	For penicillin intolerance: Erythromycinethylsuccinate	Sanasepton forte	250	300	375	500	750	1000	mg
Staphylococci	Dicloxacillin	InfectoStaph	330	400	500	670	1000	1330	mg
Staphylococci	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).