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TEXTBOOK PRESENTATION

Most commonly seen in children, bullous impetigo presents as flaccid, transparent bullae in the intertriginous areas. The blisters rupture easily and leave a rim of scale and shallow moist erosion.

DISEASE HIGHLIGHTS

  1. Description of the lesion: flaccid bullae on normal skin (Figure 29-5)

  2. Location of the lesion

    1. Develops on grossly intact skin as a result of local toxin production.

    2. This is in contrast to nonbullous impetigo, shown in Figure 29-6, resulting from Staphylococcus or Streptococcus infection, which tends to affect previously traumatized skin.

    3. Lesions most commonly develop on moist, intertriginous skin.

  3. Superficial skin infection that most commonly affects infants and young children

  4. The causative agent is Staphylococcus aureus.

  5. The blistering is caused by the production of exfoliatin or epidermolytic toxins.

EVIDENCE-BASED DIAGNOSIS

  1. Diagnosis is by clinical presentation.

  2. Culture of blister fluid or the moist edge of a crusted plaque may be diagnostic.

TREATMENT

  1. Oral antibiotics active against S aureus should be prescribed for bullous impetigo. The possibility of methicillin-resistant S aureus (MRSA) must be considered.

  2. Localized, nonbullous impetigo may be adequately treated with topical antibiotics (effective against gram-positive cocci) such as:

    1. Bacitracin

    2. Polymyxin

    3. Mupirocin

  3. Recurrent infections may indicate staphylococcal carriage. Eradication measures including daily washing with chlorhexidine gluconate, intranasal mupirocin ointment, and oral rifampin and doxycycline have been modestly successful.

  4. Family members and close contacts may also be colonized and warrant investigation and treatment when appropriate. Environmental sources such as shared towels and athletic equipment should be considered.

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