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Key Features

  • A contagious and autoinoculable infection of the skin caused by staphylococci or rarely streptococci

Clinical Findings

  • The lesions consist of macules, vesicles, bullae, pustules, and honey-colored gummy crusts that when removed leave denuded red areas

  • The face and other exposed parts are most often affected

  • Ecthyma is a deeper form of impetigo caused by staphylococci or streptococci, with ulceration and scarring; it occurs frequently on the extremities

Diagnosis

  • Gram stain and culture confirm the diagnosis

  • Differential diagnosis

    • Contact dermatitis (acute)

    • Herpes simplex

Treatment

  • Soaks and scrubbing can be beneficial, especially in unroofing lakes of pus under thick crusts

  • Topical agents such as bacitracin 500 units/g applied twice daily, mupirocin 2% ointment applied three times daily, or retapamulin 1% ointment applied twice daily can be attempted for 5–14 days for infections limited to small areas

  • Cephalexin, 250 mg four times daily orally

  • Doxycycline, 100 mg twice daily orally, or trimethoprim-sulfamethoxazole, double-strength twice daily orally, can be used for penicillin allergy and methicillin-resistant Staphylococcus aureus

  • Recurrent impetigo, which is due to nasal carriage of S aureus, is treated with rifampin, 600 mg once daily orally, or mupirocin intranasal ointment applied intranasally twice daily for 5 days

  • Bleach baths (1/4 to 1/2 cup per 20 L of bathwater for 15 minutes 3–5 times weekly) for all family members may help reduce the spread

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