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For further information, see CMDT Part 6-25: Impetigo
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Essentials of Diagnosis
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Superficial blisters filled with purulent material that rupture easily
Crusted superficial erosions
Positive Gram stain and bacterial culture
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General Considerations
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A contagious and autoinoculable infection of the skin caused by staphylococci or rarely streptococci
In temperate climates, most cases are associated with Staphylococcus aureus infection
Streptococcus species are more common in tropical climates
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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
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Differential Diagnosis
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Soaks and scrubbing can be beneficial, especially in unroofing lakes of pus under thick crusts
For infections limited to small areas, first-line topical treatment options include
Mupirocin
Ozenoxacin
Retapamulin
For widespread infections, or in immunosuppressed individuals, use systemic antibiotics
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 S aureus
Recurrent impetigo, which is due to nasal carriage of S aureus, is treated with rifampin, 300 mg orally twice daily, 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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Galli
L
et al; Italian Pediatric Infectious Diseases Society; Italian Pediatric Dermatology Society. Common community-acquired bacterial skin and soft-tissue infections in children: an intersociety consensus on impetigo, abscess, and cellulitis treatment. Clin Ther. 2019 Mar;41(3):532–51.
[PubMed: 30777258]
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Kosar
L
et al. Management of impetigo and cellulitis: Simple considerations for promoting appropriate antibiotic use in skin infections. Can Fam Physician. 2017 Aug;63(8):615–8.
[PubMed: 28807958]