Impetigo

• Highly contagious bacterial skin infection.
• Common in children.
• Characterized by pustules and honey-coloured crusts.

• Most common bacterial skin infection in children.
• Higher prevalence in warm, humid climates.
• Peak incidence in children aged 2-5 years.

• Caused by Staphylococcus aureus or Streptococcus pyogenes.
• Bacteria enter through minor skin trauma → Infection spreads superficially in the epidermis.
• Can be non-bullous or bullous form.

• Non-bullous impetigo: more common, small pustules.
• Bullous impetigo: large fluid-filled blisters.
• Ecthyma: deeper form, ulcers with thick crusts.

• Painless pustules that rupture.
• Honey-coloured crusts form over lesions.
• Pruritus (itching).
• Occasional lymphadenopathy.

• Erythematous base around lesions.
• Multiple small vesicles or pustules.
• Characteristic golden-yellow crusts.
• Bullae (bullous impetigo).

• Clinical diagnosis primarily.
• Swab for culture and sensitivity.
• Exclude other conditions (eczema, herpes).

• Topical antibiotics (e.g., fusidic acid).
• Hydrogen peroxide 1% cream
  • According to NICE, patients with localised non-bullous impetigo who are not systematically unwell, can be offered Hydrogen peroxide 1% cream.
• Oral antibiotics for extensive infection (e.g., flucloxacillin).
• Maintain good hygiene to prevent spread.
• Avoid close contact with others during active infection.

• Post-streptococcal glomerulonephritis.
• Cellulitis.
• Scar formation.
• Recurrent infections.

• Excellent with appropriate treatment.
• Recurrence is common.
• Follow-up to ensure resolution and prevent complications.

• Highly contagious; prompt treatment reduces spread.
• Distinguish between non-bullous and bullous forms.
• Non-bullous impetigo can be treated effectively with either topical antibiotics or hydrogen peroxide 1% cream. 
• Bullous impetigo can be managed with oral antibiotics, often flucloxacillin.
• Education on hygiene and prevention crucial.

NICE (2020). Recommendations | Impetigo: antimicrobial prescribing | Guidance | NICE. [online] Nice.org.uk. Available at: https://www.nice.org.uk/guidance/ng153/chapter/Recommendations.