This document provides information about impetigo, a common skin infection seen mostly in children. It defines impetigo and describes how it is transmitted through direct contact. It notes that impetigo occurs more commonly in hot, humid weather and when the skin barrier is disrupted. The document outlines the epidemiology of impetigo, describing who is most affected. It discusses the etiology, describing the bacteria that cause impetigo and the different types. It provides details on clinical manifestations, diagnosis, pathophysiology, treatment options including antibiotics, and concludes by thanking the reader.

1. IMPETIGO
By,
Dr.A.Infant Smily Pharm D.,
Assitant Professor,
Department of Pharmacy Practice,
RVSCOPS, Coimbatore.

2. DEFINITION
• Impetigo is a superficial skin infection that is seen most
commonly in children and is transmitted easily from person to
person.
• Mostly from direct contact with someone who has it.Can be
transmitted through:
1. towels,
2. toys,
3. clothing or
4. household items
NN-
BULLO
US

3. Impetigo is most common during hot, humid weather,
which facilitates microbial colonization of the skin.
Minor trauma, such as scratches or insect bites, allows
entry of organisms into the superficial layers of skin,
and infection ensues.
Impetigo is highly communicable and readily spreads
through close contact, especially among siblings and
children in daycare centers and schools

4. • There are two ways an initial infection can occur:
• primary impetigo - is when the bacteria invades the
skin through a cut , insect bite, or other injury, and
• secondary impetigo - is where the bacteria invades
the skin because the skin barrier has been disrupted
by another skin infection, such as scabies or eczema.

5. EPIDEMIOLOGY
• An estimated 162 million children worldwide have
impetigo at any one time.
• Impetigo is more common in developing countries
and in poor areas of industrial countries.
• The highest numbers of cases are in areas like
Oceania, which includes Australia, New Zealand, and
several other countries.

6. • Caused by S. pyogenes
• But S. aureus either alone or in combination with S.
pyogenes has emerged more recently as the
principal cause of impetigo
• The bullous form is caused by strains of S. aureus
capable of producing exfoliative toxins
ETIOLOGY

7. STAGES OF IMPETIGO BY TYPE
• There are three types of impetigo based on the
bacteria that cause them and the sores they form.
Each type goes through a series of stages.
1. Non Bullous impetigo
2. Bullous impetigo
3. Ecthyma

8. BULLOUS IMPETIGO (BLISTERS)
• This form is caused by Staphylococcus aureus
bacteria that produce a toxin that causes a break
between the top layer (epidermis) and the lower
levels of skin forming a blister. (The medical
term for blister is bulla.)
• The blisters start on unbroken skin and aren’t
surrounded by reddish areas. The blisters
become limp and clear, and then burst open.
• The blisters usually leave no scars behind when
they heal.

9. NON -BULLOUS IMPETIGO
This is the common form, caused by
Staphylococcus aureus. It appears as small
blisters or scabs, which then form yellow or
honey-colored crusts.
 These often start around the nose and on the
face, but they also may affect the arms and
legs. At times , there may be swollen glands
nearby.

10. ECTHYMA
 This more serious infection is much less common.
It occasionally happens when impetigo isn’t
treated.
 The infection forms painful blisters on the skin of
the buttocks, thighs, legs, ankles, and feet.
 The blisters turn into pus-filled sores with a
thicker crust. Often, the skin around the sores
turns red.
 Ecthyma sores heal slowly and may leave scars
after they heal.

11. CLINICAL MANIFESTATION
Symptoms
• The first signs of impetigo are reddish sores on the skin, often
clustered around the nose and lips. These sores quickly grow
into blisters, ooze and burst, and then form a yellowish crust.
• The clusters of blisters may expand to cover more of the skin.
Sometimes the red spots just develop a yellowish crust without
any blisters being seen.
• Skin lesions ,Swollen lymph nodes ,Spreading of lump to other
skin areas,open sores with a yellow crust , accumulation of
fluids in the lumps,Painful blisters are common.

12. Signs
• Non bullous impetigo manifests initially as small, fluid filled
vesicles.These lesions rapidly develop into pus-filled blisters that
rupture readily. Purulent discharge from the lesions dries to form
golden- yellow crusts that are characteristic of impetigo.
• In the bullous form of impetigo, the lesions begin as vesicles and
turn into bullae containing clear yellow fluid.
Bullae soon rupture, forming thin, light brown crusts. Regional
lymph nodes may be enlarged.

13. PATHOPHYSIOLOGY
• Bullous impetigo is caused by staphylococci producing
exfoliative toxin that contains serine proteases acting on
desmoglein , a structurally critical peptide bond in a molecule
that holds epidermal cells together.
• This process allows Staphylococcus aureus to spread under the
stratum corneum in the space formed by the toxin, causing the
epidermis to split just below the stratum granulosum. Large
blisters then form in the epidermis with neutrophil .

14. • In bullous impetigo, the bullae rupture quickly,
causing superficial erosion and a yellow crust,
• while in non-bullous impetigo, Streptococcus typically
produces a thick-walled pustule with an erythematous
base.
• Histology of non-bullous established lesions shows a thick
surface crust composed of serum and neutrophils in
various stages of breakdown with parakeratotic material.
PATHOPHYSIOLOGY CONT’D

16. DIAGNOSIS
• Laboratory Tests:
 Pus Cultures.
 Crusted tops of lesions should be raised so that purulent material at
the base of the lesion can be cultured.
 Cultures should not be collected from open, draining skin pustules
because they may be colonized with staphylococci and other normal
skin flora.
• Other Diagnostic Tests
 A complete blood count is often performed because leukocytosis is
common.

17. TREATMENT
NON – PHARMACOLOGY
• Impetigo is not serious, may go away and dry up on its own, and is
easy to treat.
• Clean and soak the sores three to four times a day until the sores heal.
Gently clean the sores with warm water and soap, and then remove the
crusts.
• Bath and wash hands often to cut down on skin bacteria.
• Cover any skin wounds or insect bites to protect the area.
• Keep nails clipped and clean.
• Don’t touch or scratch open sores. This will spread the infection.

18. • More severe or widespread cases, especially of bullous
impetigo, may require oral antibiotic medication for impetigo.
• With treatment, impetigo usually heals in 7 to 10 days unless
there is an underlying infection or skin diseases.
• Treatment failures could be a result of noncompliance or
antimicrobial resistance.
• A follow-up culture of exudates should be collected for culture and
sensitivity, with treatment modified accordingly
PHARAMACOLOGICAL

19. DRUGS PEDIATRIC DOSE ADULT DOSE
Penicillinase resistant
penicillins
(dicloxacillin)
12.5 mg/kg orally daily in
four divided
doses for children
250 -500 mg q6h
Cephalexin 25–50 mg/kg orally daily
in two divided doses
for children
250 – 500mg q8h.
cefadroxil 30 mg/kg orally daily in
two divided doses for
children
500 mg q 12h
Penicillin administered as either
a single intramuscular dose
of benzathine penicillin G
300,000– 600,000 units in
children,
1.2 million units in adults

20. DRUGS PEDIATRIC DOSE ADULT DOSE
clindamycin children 10–30
mg/kg per day in three to
four divided doses
The duration of therapy
is 7 to
10 days.
150–300 mg orally
every 6 to 8 hours. The
duration of therapy is 7
to 10 days.
Topical antibiotics, such
as mupirocin and
bacitracin
every 8 h every 8 h
Mupirocin ointment Applied three times daily
for 7 days
Applied three times daily
for 7 days

21. THANK YOU